Operable implant

ABSTRACT

An operable implant adapted to be implanted in the body of a patient. The operable implant comprising an operation device and a body engaging portion, the operation device comprises an electrical motor comprising a static part comprising a plurality of coils and a movable part comprising a plurality of magnets, such that sequential energizing of said coils magnetically propels the magnets and thus propels the movable part. The operation device further comprises an enclosure adapted to hermetically enclose the coils of the static part, such that a seal is created between the static part and the propelled moving part with the included magnets, such that the coils of the static part are sealed from the bodily fluids, when implanted.

TECHNICAL FIELD

The present invention relates to the field of operable implants, anddevices, systems and methods for energizing and communicating withoperable implants.

BACKGROUND

Providing a reliable operation device for energized and operableimplants has proven to be difficult. The hostile environment of the bodyaffects all parts of an implant and moving parts are particularlysensitive to bodily fluids and fibrotic tissue growth. Fibrotic tissuewill eventually surround and enclose all foreign matter placed in thebody which risks affecting the function of an implant. A more reliable,general purpose operation device for operable implants would thus beadvantageous.

SUMMARY

An operable implant adapted to be implanted in the body of a patient isprovided. The operable implant comprises an operation device and a bodyengaging portion. The operation device comprises a first unitcomprising: a receiving unit for receiving wireless energy, and a firstgear system adapted to receive mechanical work having a first force andfirst velocity, and output mechanical work having a different secondforce and a different second velocity. The operation device furthercomprises a second unit comprising an electrical motor adapted totransform electrical energy to the mechanical work, and a distanceelement comprising: a lead for transferring the electrical energy fromthe first unit to the second unit, and a mechanical transferring memberadapted to transfer the mechanical work from the electrical motor in thesecond unit to the gear system in the first unit. The distance elementis adapted to separate the first and second units such that thereceiving unit, when receiving wireless energy, is not substantiallyaffected by the second unit.

According to one embodiment, the receiving unit comprises at least onecoil adapted to transform wireless energy received in form of a magneticfield into electrical energy. The receiving unit may comprise at least afirst coil having a first number of windings, and at least a second coilhaving a second, different number of windings.

According to one embodiment, the gear system comprises an operableelement, a first gear having the shape of a hollow cylinder, comprisinga first number of teeth, on the peripheral outside thereof, and a secondgear having the shape of a hollow cylinder, comprising a greater numberof teeth than the first gear, on the inside surface thereof. Theoperable element may be adapted to engage the inside of the first gear,such that the outside of the first gear is pressed against the inside ofthe second gear such that the teeth of the first gear are interengagedwith the teeth of the second gear in at least one position interspacedby positions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear.

According to one embodiment, operable element comprises at least one of;a planetary gear and a structure or wheel at least partly using frictionto interconnect with the first gear.

According to one embodiment, the second unit comprises a second gearsystem adapted to receive the mechanical work output from the first gearsystem with the different second force and the different second velocityas input, and output mechanical work having a third different force andthird different velocity. The gear system of the second unit may beconnected in series with the gear system of the first unit, via themechanical transferring member of the distance element.

In one embodiment, the first unit may comprise a second gear systemadapted receive mechanical work of a first force and velocity as input,and output mechanical work having a different force and velocity. Thesecond gear system may be connected in series with the first gearsystem.

In any of the embodiments herein, the first unit may be adapted to beplaced at least in one of the following places: subcutaneously,subcutaneously in the abdominal wall and in the abdomen.

The electrical motor in any of the embodiments, may comprise magneticmaterial, and the first unit may remain substantially unaffected by themagnetic material in the second unit, during wirelessly energy transfer.

The first gear system in any of the embodiments may comprise a thirdgear, and the inside of the third gear may comprise the same amount ofteeth as the outside of the first gear, and the teeth of the third gearare adapted to interengage with the teeth of the first gear such thatthe third gear rotates in relation to the second gear, along with the atleast one interengaged position.

The second unit in any of the embodiments may comprise at least onefixation portion for fixating the second unit to at least one of:fibrosis, a fascia and a muscular layer towards the inside of thesubcutaneous space of the patient.

The distance element in any of the embodiments may be adapted to be atleast one of; placed through the muscular layers of the abdominal wall,and fixated to the muscular fascia facing the subcutaneous space.

According to one embodiment, the distance element is flexible such thatthe first and second unit can move in relation to each other.

The mechanical transferring member in any of the embodiments maycomprise a mechanical transferring member selected from: a hydraulictube for transferring hydraulic force, a rotating shaft for transferringrotational force, a flexible member for transferring rotational force, awire, a belt, a rod, a worm gear, and a gear for changing rotationalforce in substantially 90 degrees direction.

The operable implant may further comprise an enclosure adapted tohermetically enclose the operable implant.

According to one embodiment, the medical device may further comprise ametallic enclosure adapted to enclose at least one of the second unitand the distance element. The metallic enclosure could be a titaniumenclosure and/or an aluminum enclosure and/or a stainless steelenclosure.

One of the first and second units may comprise a battery adapted tostore electrical energy received at the receiving unit.

The electrical motor may comprise an electrical motor selected from: analternating current (AC) electrical motor, a direct current (DC)electrical motor, a linear electrical motor, an axial electrical motor,a piezo-electric motor, a three-phase motor, a more than one-phasemotor, a bimetal motor, and a memory metal motor.

According to one embodiment, the implantable system further comprises acontrol unit for controlling at least one parameter of at least one of:the operation device, and the body engaging portion.

The electrical motor may in one embodiment be an alternating current(AC) motor, and the control unit may comprise a frequency converter foraltering the frequency of an alternating current for controlling thealternating current motor.

The first unit of the operable implant may comprise a hydraulic pumpadapted to transfer mechanical work into hydraulic power for powering ahydraulically operable body engaging portion. The hydraulic pump may beconnected to the force output of the first or second gear system. Thehydraulic pump may be a hydraulic pump selected from: at least onereservoir acting as a pump by a wall moving by the mechanical work, atleast one reservoir acting as a pump to move fluid by changing volume,at least one non-valve pump, at least one valve pump, at least oneperistaltic pump, at least one membrane pump, at least one gear pump,and at least one bellows pump.

According to one embodiment, the first unit comprises a reservoir forsupplying fluid to a hydraulically operable body engaging portion.

The operable implant may comprise a third unit comprising a secondreservoir for supplying fluid to a hydraulically operable body engagingportion. The reservoir may be operable and may comprise at least onemovable wall portion.

The reservoir may comprise at least one of; at least one bellows shapedportion, a shape adapted to allow movement although covered withfibrosis and a plate shaped surface, in all cases enabling movement ofthe at least one movable wall portion.

The reservoir in any of the embodiments may be in fluid connection witha hydraulically operable body engaging portion, and the reservoir may beadapted to operate the hydraulically operable body engaging portion bymovement of the at least one movable wall portion. The reservoir may becircular or torus shaped.

The operable implant may further comprise a threaded member arranged tomove the wall portion of the reservoir.

In one embodiment, the operable implant further comprises at least oneof: a pressure sensor, a flow sensor and position sensor arranged inconnection with at least one of the pump and the reservoir fordetermining the pressure and/or volume in the reservoir, and thepressure or flow from the hydraulic pump.

The first unit of the operable implant of any of the embodiments maycomprise an injection port for supplying fluid to at least one of: a/thereservoir, and a/the hydraulically operable body engaging portion.

According to one embodiment, at least one of the first unit and thedistance element may be free from at least one of: metallic andmagnetizable components.

At least one of the first and second unit and the distance element maybe free from magnetic components.

The first unit of the operable implant may comprise a communication unitadapted to wirelessly communicate with an external unit on the outsideof the body of the patient.

The operable element may be adapted to deflect the first gear, and tomaintain the first gear deflected such that the teeth of the first gearare interengaged with the teeth of the second gear in at least one of;one position, two positions, three positions, and four or morepositions. The two, three or four positions are angularly spacedpositions interspaced by positions at which the teeth are notinterengaged.

An operable implant for implantation in the body of a patient is furtherprovided. The operable implant may comprise an operation device and abody engaging portion. The operation device comprises an electricalmotor comprising: a set of coils circularly distributed around arotational axis of the electrical motor, a set of magnets connected to arotatable structure at least partially axially overlapping said coils,such that sequential energizing of said coils magnetically propels themagnets and causes the rotatable structure to rotate around therotational axis, a gear system comprising: an operable element, a firstgear having the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof. The operable element maybe adapted to engage the inside of the first gear, such that the outsideof the first gear is pressed against the inside of the second gear suchthat the teeth of the first gear are interengaged with the teeth of thesecond gear in at least one position interspaced by positions at whichthe teeth are not interengaged, and wherein the operation of theoperable element advances the positions and thereby causes relativerotation between the first gear and the second gear. The second gear hasa smaller diameter than the rotatable structure and is at leastpartially placed in the same axial plane, such that the rotatablestructure at least partially axially overlaps the second gear, such thatthe gear system is at least partially placed inside of the electricalmotor. Placing the gear system at least partially inside of theelectrical motor creates a very compact and efficient design.

The operable element may be adapted to deflect the first gear, and tomaintain the first gear deflected such that the teeth of the first gearare interengaged with the teeth of the second gear in at least one of;one position, two positions, three positions, and four or morepositions, wherein the two, three and four positions are angularlyspaced positions interspaced by positions at which the teeth are notinterengaged.

According to one embodiment of the operable implant, the operableelement is adapted to deflect the first gear, and to maintain the firstgear deflected such that the teeth of the first gear are interengagedwith the teeth of the second gear in at least two angularly spacedpositions interspaced by positions at which the teeth are notinterengaged.

The operable implant may comprise at least one of; a planet gear and astructure or wheel at least partly using friction to interconnect withthe first gear.

According to one embodiment, the operation device further comprises asecond gear system comprising: an operable element, a first gear havingthe shape of a hollow cylinder, comprising a first number of teeth, onthe peripheral outside thereof, and a second gear having the shape of ahollow cylinder, comprising a greater number of teeth than the firstgear, on the inside surface thereof, wherein the operable element isadapted to engage the inside of the first gear, such that the outside ofthe first gear is pressed against the inside of the second gear suchthat the teeth of the first gear are interengaged with the teeth of thesecond gear in at least one position interspaced by positions at whichthe teeth are not interengaged, and wherein the operation of theoperable element advances the positions and thereby causes relativerotation between the first gear and the second gear, wherein the firstgear of the first gear system is directly or indirectly connected to theoperable element of the second gear system, such that the first gearsystem is connected in series with the second gear system, such that thefirst gear system receives mechanical work having a first force andfirst velocity and outputs mechanical work having a second, different,force and a second, different, velocity, and the second gear systemreceives the output mechanical work from the first gear system, asinput, and outputs mechanical work with a third different force andthird different velocity.

The first and second gear systems in any of the embodiments herein maybe positioned coaxially, along the rotational axis of the first andsecond gear systems.

The second gear of at least one of; the first and second gear system mayhave a smaller diameter than the rotatable structure and be at leastpartially placed in the same axial plane, such that the rotatablestructure at least partially axially overlaps the second gear of atleast one of; the first and second gear system, such that at least oneof; the first and second gear system is at least partially placed insideof the electrical motor.

The first and second gears of the second gear system may have a largerdiameter than the rotatable structure, and be at least partially placedin the same axial plane, such that the first and second gears of thesecond gear system at least partially axially overlaps the rotatablestructure, such that the electrical motor is at least partially placedinside the second gear system.

According to one embodiment, operable implant further comprises aradially extending connecting structure directly or indirectlyconnecting the first gear of the first gear system to the operableelement of the second gear system, to transfer force from the first gearsystem to the second gear system.

The first gear system of the operable implant may comprise a third gear,and the inside of the third gear may comprise the same amount of teethas the outside of the first gear. The teeth of the third gear is adaptedto interengage with the teeth of the third gear such that the third gearrotates in relation to the second gear, along with the angularly spacedpositions.

In any of the embodiments, the first gear of the first gear system mayindirectly connect with the operable element of the second gear systemvia the third gear.

The rotatable structure of the operable element may be placed radiallyon the inside of the circularly distributed coils or placed radially onthe outside of the circularly distributed coils.

According to one embodiment, the operable implant further comprises acoil enclosure adapted to enclose the coils, such that the coils remainenclosed during operation of the operation device.

According to one embodiment, the first gear of at least one of; thefirst and second gear system may directly or indirectly connect to athreaded member adapted to transform the radially rotating force to anaxially reciprocating force.

The threaded member of the operable implant may directly or indirectlyconnect to a movable wall portion of a first reservoir for changing thevolume of the first reservoir.

The threaded member may be directly or indirectly connected to a movablewall portion of a second reservoir for changing the volume of the secondreservoir. The movement of the movable wall portion of the firstreservoir by the threaded member in a first direction causes the firstreservoir to expand and the volume in the reservoir to increase, andwherein the movement of the movable wall of the second reservoir by thethreaded member in a first direction causes the second reservoir tocontract and the volume in the second reservoir to decrease.

The first reservoir in any of the embodiments may be in fluid connectionwith a first hydraulically operable body engaging portion, and thesecond reservoir in any of the embodiments may be in fluid connectionwith a second hydraulically operable body engaging portion. Operation ofthe electrical motor in a first direction, via the gear system and itsdirect or indirect connection with the threaded member, causes:transportation of fluid from the first reservoir to the firsthydraulically operable body engaging portion, and transportation offluid from the second hydraulically operable body engaging portion tothe second reservoir.

The reservoir in any of the embodiments may be at least one of: circularand torus shaped.

According to one embodiment of the medical device, the operation devicemay comprise a circular reservoir encircling the operation device, andthe circular reservoir may comprise a movable wall portion adapted tocompress and expand the circular reservoir, thereby altering the volumeof the reservoir, and the movable wall portion may be connected to theoperation device, such that the operation of the operation devicechanges the volume of the circular reservoir.

According to one embodiment of the operable implant, a portion of thewall of the reservoir comprises at least one of: a bellows structure, ashape adapted to allow movement although covered with fibrosis, and aplate shaped surface, in all cases enabling movement of the at least onemovable wall portion, enabling the compression and/or expansion of thereservoir.

According to one embodiment, the operable implant further comprises aperistaltic pump comprising a hollow member for fluid transportation,and an operable compression member adapted to engage and compress thehollow member. The first gear of the operable implant may be in director indirect connection with the compression member, such that theoperation of the electrical motor operates the compression member suchthat fluid is transported in the hollow member. The operable compressionmember may be connected to the third gear of any of the embodimentsherein.

The hollow member of the peristaltic pump may form a loop or part of aloop adapted to at least partially encircle the operation device in atleast partially the same axial plane. The operation device may beadapted to propel the compressing member such that the compressionmember compresses the hollow member towards the outer periphery of theloop or part of loop.

According to one embodiment, the operation device comprises analternating current (AC) motor, and the operation device furthercomprises a frequency converter for altering the frequency of analternating current for controlling the alternating current motor.

According to one embodiment of the operable implant, the operableimplant further comprises a separate unit comprising a receiving unitadapted to receive wireless energy transmitted from outside the body.The receiving unit may comprise at least one coil adapted to transformwireless energy received in form of a magnetic, electric orelectromagnetic field into electrical energy.

The receiving unit in the embodiments may comprise at least a first coilhaving a first number of windings, and at least a second coil having asecond, different number of windings.

According to one embodiment, the separate unit may be adapted to beplaced at least one of; subcutaneously and subcutaneously in theabdominal wall.

The operable implant according to any one of the preceding embodimentsmay further comprise at least one fixation portion for fixating at leasta part of the operable implant to at least one of fibrosis, a fascia anda muscular layer towards the inside of the subcutaneous space of thepatient.

The operable implant according to any one of the preceding embodimentsmay further comprise a distance element connecting the operation deviceand the separate unit, the distance element may comprise an electriclead adapted to transfer electrical energy between the separate unit andthe operation device. The distance element may be adapted to be placedthrough the muscular layers of the abdominal wall and/or be fixated tothe muscular fascia facing the subcutaneous space.

According to one embodiment, the distance element may be flexible suchthat the first and second unit can move in relation to each other.

The separate unit in any of the embodiments may comprise a reservoir forsupplying fluid to a hydraulic implant.

The distance element in any of the embodiments herein may comprise afluid conduit for transportation of fluid from the operation device toseparate unit to control the size of the reservoir, or in the oppositedirection. The distance element may further comprise a mechanicaltransferring member adapted to transfer mechanical work from theoperation device to the separate unit. The mechanical transferringmember may comprise a mechanical transferring member selected from: ahydraulic tube for transferring hydraulic force, a rotating shaft fortransferring rotational force, a flexible member for transferringrotational force, a wire, a belt, a rod, a worm gear, and a gear forchanging rotational force in substantially 90 degrees direction.

The operable implant may further comprise an enclosure adapted tohermetically enclose the operation device and the separate unit, suchthat the operation device and the separate unit are sealed from bodilyfluids when implanted.

At least one of the operation device and the separate unit may comprisea battery adapted to store electrical energy received at the receivingunit. The separate unit may further comprise an injection port forsupplying fluid to the reservoir and/or the body engaging portion beinghydraulically operable.

The separate unit, apart from the energy receiving unit, may be freefrom metallic and/or magnetizable and/or magnetic components, such thatthe elements of the separate unit does not interfere with the wirelessenergy transfer.

The separate unit may further comprise a control unit for controlling atleast one parameter of at least one of: the operation device, and thebody engaging portion.

The separate unit may comprise a communication unit adapted towirelessly communicate with an external unit on the outside of the bodyof the patient.

In one embodiment, the operable implant may comprise a hydraulic pumpselected from: at least one reservoir with a wall moving by themechanical work acting as a pump, at least one reservoir changing volumeto move fluid acting as a pump, at least one non-valve pump, at leastone valve pump, at least one peristaltic pump, at least one membranepump, at least one gear pump, and at least one bellows pump.

The operable implant may comprise an electrical motor selected from: analternating current (AC) electrical motor, a direct current electricalmotor, a linear electrical motor, an axial electrical motor, apiezo-electric motor, a three-phase motor, a more than one-phase motor,a bimetal motor, and a memory metal motor.

An operable implant adapted to be implanted in the body of a patient,the operable implant comprises an operation device and a body engagingportion, wherein the operation device comprises: an axial electricalmotor comprising: a set of coils circularly distributed around arotational axis of the electrical motor, a set of magnets connected to aradially extending rotatable structure at least partially radiallyoverlapping said magnets, such that sequential energizing of said coilsmagnetically axially propels the magnets and causes rotation of therotatable structure around the rotational axis. The operable implantfurther comprises a gear system comprising: an operable element, a firstgear having the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof, wherein the operableelement is adapted to engage the inside of the first gear, such that theoutside of the first gear is pressed against the inside of the secondgear such that the teeth of the first gear are interengaged with theteeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear. Thegear system and the axial electrical motor are positioned coaxially,along the rotational axis of electrical motor, which creates a compactdesign with few moving parts.

The operable element may comprise at least one of: a planet gear, and astructure or wheel at least partly using friction to interconnect withthe first gear.

According to one embodiment, the first set of coils are circularlydistributed around a rotational axis of the electrical motor andpositioned on a magnetizable core structure. The radially extendingrotatable structure comprises a rotatable disc, and the magnetizablecore structure and the rotatable disc are positioned coaxially and therotatable disc is connected to a driving shaft connected to the operableelement.

According to one embodiment, the operation device further comprises asecond magnetizable core structure comprising a second sets of coils,wherein the second magnetizable core structure is coaxially positionedto at least partly overlap the magnets of the rotatable disc, such thatthe first set of coils propels the magnets on the first side thereof,and the second sets of coils propels the magnets on the second sidethereof.

According to one embodiment, the peripheral diameter of the circularconfiguration of at least one of the first and second set of coils issmaller than the inner diameter of the first gear, and the first andsecond set of coils are positioned in the same axial plane as the firstgear, such that the axial electrical motor is at least partially placedinside of the gear system.

According to one embodiment, the rotatable disc is directly connected tothe operable element.

The operable implant may further comprise a coil enclosure adapted toenclose the coils, such that the coils remain enclosed separated fromthe magnets during operation of the operation device.

According to one embodiment, the operable element is adapted to deflectthe first gear, and to maintain the first gear deflected such that theteeth of the first gear are interengaged with the teeth of the secondgear in one of; one position, two positions, three positions, and fouror more positions. The two, three and four positions are angularlyspaced positions interspaced by positions at which the teeth are notinterengaged.

The operation device of the operable implant may further comprise asecond gear system comprising: an operable element, a first gear havingthe shape of a hollow cylinder, comprising a first number of teeth, onthe peripheral outside thereof, and a second gear having the shape of ahollow cylinder, comprising a greater number of teeth than the firstgear, on the inside surface thereof, wherein the operable element isadapted to engage the inside of the first gear, such that the outside ofthe first gear is pressed against the inside of the second gear suchthat the teeth of the first gear are interengaged with the teeth of thesecond gear in at least one position interspaced by positions at whichthe teeth are not interengaged, and wherein the operation of theoperable element advances the positions and thereby causes relativerotation between the first gear and the second gear. The first gear ofthe first gear system is directly or indirectly connected to theoperable element of the second gear system, such that the first gearsystem is connected in series with the second gear system, such that thefirst gear system receives mechanical work having a first force andfirst velocity and outputs mechanical work having a second, different,force and a second, different, velocity, and the second gear systemreceives the output mechanical work from the first gear system, asinput, and outputs mechanical work with a third different force andthird different velocity.

The first and second gear systems may be positioned coaxially, along therotational axis of the first and second gear systems.

The operable implant may further comprise a radially extendingconnecting structure directly or indirectly connecting the first gear ofthe first gear system to the operable element of the second gear system,to transfer force from the first gear system to the second gear system.

The first gear system in any of the embodiments may comprise a thirdgear, and the inside of the third gear may comprise the same amount ofteeth as the outside of the first gear. The teeth of the third gear maybe adapted to interengage the teeth of the third gear such that thethird gear rotates in relation to the second gear, along with theangularly spaced positions.

According to one embodiment, the first gear of the first gear systemindirectly connects with the operable element of the second gear systemvia the third gear in any of the embodiments.

The first gear of the first gear system could be directly or indirectlyconnected to a threaded member adapted to transform the radiallyrotating force to an axially reciprocating force.

According to one embodiment, the threaded member could be directly orindirectly connected to a movable wall of a first or second reservoirfor changing the volume of the reservoir.

According to one embodiment, the movement of the movable wall of thefirst reservoir by the threaded member in a first direction causes thefirst fluid reservoir to expand and the volume in the first fluidreservoir to increase, and the movement of the movable wall of thesecond reservoir by the threaded member in a first direction causes thesecond reservoir to contract and the volume in the second reservoir todecrease.

The first reservoir of the operable implant may be in fluid connectionwith a first hydraulically operable body engaging portion, and thesecond reservoir is in fluid connection with a second hydraulicallyoperable body engaging portion, and wherein operation of the electricalmotor in a first direction, by the via the gear system and its direct orindirect connection with the threaded member, causes: transportation offluid from the first reservoir to the first hydraulically operable bodyengaging portion, and transportation of fluid from the secondhydraulically operable body engaging portion to the second reservoir.

The reservoir in any of the embodiments herein could be a circular ortorus shaped reservoir. In one embodiment the operation device comprisesa circular reservoir encircling the operation device, and the circularreservoir comprises a movable wall portion adapted to compress andexpand the circular reservoir, thereby altering the volume of thereservoir, and wherein the movable wall portion is connected to theoperation device, such that the operation of the operation devicechanges the volume of the circular reservoir.

A portion of the wall of the reservoir could comprise at least one of; abellows structure, a shape adapted to allowing movement although coveredwith fibrosis and a plate shaped surface, in all cases enabling movementof the at least one movable wall portion, enabling the compressionand/or expansion of the reservoir.

According to one embodiment, the operable implant further comprises aperistaltic pump, and the peristaltic pump comprises a hollow member forfluid transportation, and an operable compression member adapted toengage and compress the hollow member. The first gear is in direct orindirect connection with the compression member, such that the operationof the electrical machine operates the compression member such thatfluid is transported in the hollow member.

According to one embodiment, the operable compression member isconnected to the third gear of any of the embodiments herein.

According to one embodiment, the hollow member of the peristaltic pumpforms a loop or part of a loop adapted to at least partially encirclethe operation device in at least partially the same axial plane. Theoperation device is adapted to propel the compressing member such thatthe compression member compresses the hollow member towards the outerperiphery of the loop or part of loop.

According to one embodiment, the operation device comprises analternating current (AC) motor, and the operation device furthercomprises a frequency converter for altering the frequency of analternating current for controlling the alternating current motor.

The operable implant in any of the embodiments herein may furthercomprise a separate unit comprising a receiving unit adapted to receivewireless energy transmitted from outside the body. The separate unitcould be adapted to be placed at least one of; subcutaneously andsubcutaneously in the abdominal wall. The separate unit could comprise areservoir for supplying fluid to a hydraulic implant.

According to one embodiment, the receiving unit comprises at least onecoil adapted to transform wireless energy received in form of amagnetic, electromagnetic field into electrical energy. The receivingunit could comprise at least a first coil having a first number ofwindings, and at least a second coil having a second, different numberof windings.

The operable implant could further comprise at least one fixationportion for fixating at least part of the operable implant to at leastone of fibrosis, a fascia and a muscular layer towards the inside of thesubcutaneous space of the patient.

The operable implant may further comprise a distance element connectingthe operation device and the separate unit, the distance element couldcomprise an electric lead adapted to transfer electrical energy betweenthe separate unit and the operation device.

The distance element could be adapted to be placed through the muscularlayers of the abdominal wall and/or fixated to the muscular fasciafacing the subcutaneous space.

The distance element could be flexible such that the first and secondunit can move in relation to each other.

The distance element in any of the embodiments could comprise a fluidconduit for transportation of fluid from the operation device to controlthe size of the reservoir, or in the opposite direction.

The distance element could further comprise a mechanical transferringmember adapted to transfer mechanical work from the operation device tothe separate unit. The mechanical transferring member could be amechanical transferring member selected from: a hydraulic tube fortransferring hydraulic force, a rotating shaft for transferringrotational force, a flexible member for transferring rotational force, awire, a belt, a rod, a worm gear, and a gear for changing rotationalforce in substantially 90 degrees direction.

The operable implant may further comprise an enclosure adapted tohermetically enclose the operation device and the separate unit, suchthat the operation device and the separate unit are sealed from bodilyfluids when implanted.

At least one of the operation device and the separate unit couldcomprise a battery adapted to store electrical energy received at thereceiving unit.

The separate unit in any of the embodiments could comprise an injectionport for supplying fluid to at least one of: a or the reservoir and thebody engaging portion being hydraulically operable.

The separate unit could in one embodiment, apart from the energyreceiving unit, be free from at least one of; metallic, magnetizable andmagnetic components.

The separate unit could further comprise a control unit for controllingat least one parameter of at least one of: the operation device, and thebody engaging portion.

The separate unit could comprise a communication unit adapted towirelessly communicate with an external unit on the outside of the bodyof the patient.

According to one embodiment, the coil enclosure in any of theembodiments herein could comprise a material selected from: a carbonmaterial, a boron material, a mixture of material, a Peek® material, analloy of material, a metallic material, titanium, aluminum, a ceramicmaterial, a polymer material, polyurethane, polyether ether ketone,silicone, and Parylene® coated silicone.

The operation device of the operable implant in any of the precedingembodiments could comprise an electrical motor selected from: analternating current (AC) electrical motor, a direct current electricalmotor, a linear electrical motor, an axial electrical motor, apiezo-electric motor, a three-phase motor, a more than one-phase motor,a bimetal motor, and a memory metal motor.

An operable implant adapted to be implanted in the body of a patient isfurther provided. The operable implant comprises an operation device anda body engaging portion. The operation device could comprise anelectrical motor comprising a static part comprising a plurality ofcoils and a movable part comprising a plurality of magnets, such thatsequential energizing of said coils magnetically propels the magnets andthus propels the movable part. The operation device could furthercomprise an enclosure adapted to hermetically enclose the coils of thestatic part, such that a seal is created between the static part and thepropelled moving part with the included magnets, such that the coils ofthe static part are sealed from the bodily fluids, when implanted.

According to one embodiment, the operation device further comprises acontrol unit for controlling at least one of the operation device andthe body engaging portion, wherein the enclosure is adapted to enclosethe coils and the control unit.

The operation device of the operable implant could further comprise atleast one electrical circuit adapted to indirectly receive energy drawnfrom wireless energy supplied from outside the body of the patient,wherein the enclosure is adapted to enclose the coils and the electricalcircuit.

According to one embodiment, the operable implant comprises a separatewireless energy receiving unit comprising at least one coil adapted totransform wireless energy received in form of a magnetic, electric orelectromagnetic field into electrical energy.

The operable implant could according to one embodiment comprise adistance element adapted to create a distance between the receiving unitand the electrical motor, such that the receiving unit remainssubstantially unaffected by metallic and/or magnetic parts of the staticor movable part of the electrical motor.

The electrical motor in any of the embodiments could be an axialelectrical motor in which the coils are circularly distributed around arotational axis of the implantable electrical motor such that the centeraxis of the helix of the coils are extending in the axial direction ofthe implantable electrical motor, parallel to the rotational axis, andthe movable part comprises a radially extending rotor on which themagnets are circularly distributed around the rotational axis, themagnets in axial direction facing the coils, such that the magnets atleast partially radially overlaps said coils, such that sequentialenergizing of said coils magnetically axially propels the magnets andcauses rotation of the rotor around the rotational axis of theelectrical motor.

In alternative embodiments, the electrical motor could be a radialelectrical motor, and the coils could be circularly distributed around arotational axis of the implantable electrical motor such that the centeraxis of the helix of the coils are extending in the radial direction ofthe rotational axis of the implantable electrical motors, substantiallyperpendicular to the rotational axis, and the movable part couldcomprise an axially extending rotor on which the magnets are circularlydistributed around the rotational axis, the magnets in radial directionfacing the coils, such that the magnets at least partially axiallyoverlaps said coils, such that sequential energizing of said coilsmagnetically propels the magnets and causes rotation of the rotor aroundthe rotational axis of the electrical motor.

In alternative embodiments, the electrical motor is a linear electricalmotor in which the coils are linearly distributed along a direction ofmovement of the movable part, and the movable part comprises linearlydistributed magnets along a direction of movement of the movable part,such that sequential energizing of the coils magnetically propels themagnets and causes linear movement of the movable part.

The implantable electrical motor could be an alternating current (AC)electrical motor, and the control unit could comprise a frequencyconverter for altering the frequency of an alternating current forcontrolling the alternating current electrical motor.

According to one embodiment, the implantable electrical motor furthercomprises a second enclosure adapted to enclose the movable part, suchthat the movable part is sealed from bodily fluids when implanted.

The second enclosure could be sealingly connected to the firstenclosure, such that the enclosure wall between the movable part and thestatic part is engaged in sealing both the first enclosure and thesecond enclosure. The first and/or second enclosure could comprise amaterial selected from: a carbon material, a boron material, a mixtureof material, a Peek® material, an alloy of material, a metallicmaterial, titanium, aluminum, a ceramic material, a polymer material,polyurethane, polyether ether ketone, silicone, and Parylene® coatedsilicone.

According to one embodiment, the second enclosure is sealingly connectedto the first enclosure, such that both the movable part and a distanceelement between the movable part and the static part is sealed by thesecond enclosure.

The operable implant according to any one of the preceding embodimentscould further comprise a gear system adapted receive mechanical workhaving a first force and velocity as input, from the rotating part ofthe electrical motor, and output mechanical work having a differentforce and velocity.

The gear system could further comprise an operable element, a first gearhaving the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof. The operable elementcould be adapted to engage the inside of the first gear, such that theoutside of the first gear is pressed against the inside of the secondgear such that the teeth of the first gear are interengaged with theteeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear.

According to one embodiment, the second gear has a smaller diameter andis at least partially placed in the same axial plane as at least one ofthe movable part and the static part, such that at least one of themovable part and the static part at least partially axially overlaps thesecond gear, such that the gear system is at least partially placedinside of the electrical motor.

The operable implant may be adapted to deflect the first gear, and tomaintain the first gear deflected such that the teeth of the first gearare interengaged with the teeth of the second gear in at least one of;one position, two positions, three positions, and four or morepositions, wherein the two, three and four positions are angularlyspaced positions interspaced by positions at which the teeth are notinterengaged.

According to one embodiment, the operable element is adapted to deflectthe first gear, and to maintain the first gear deflected such that theteeth of the first gear are interengaged with the teeth of the secondgear in at least two angularly spaced positions interspaced by positionsat which the teeth are not interengaged.

The operation device in any of the embodiments herein may furthercomprise a second gear system comprising: an operable element, a firstgear having the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof, wherein the operableelement is adapted to engage the inside of the first gear, such that theoutside of the first gear is pressed against the inside of the secondgear such that the teeth of the first gear are interengaged with theteeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear. Thefirst gear of the first gear system is directly or indirectly connectedto the operable element of the second gear system, such that the firstgear system is connected in series with the second gear system, suchthat the first gear system receives mechanical work having a first forceand first velocity and outputs mechanical work having a second,different, force and a second, different, velocity, and the second gearsystem receives the output mechanical work from the first gear system,as input, and outputs mechanical work with a third different force andthird different velocity.

The first and second gear systems in any of the embodiments herein maybe positioned coaxially, along the rotational axis of the first andsecond gear systems.

The second gear of at least one of the first and second gear systemscould have a smaller diameter than the rotatable structure of any of theembodiments herein and be at least partially placed in the same axialplane, such that the rotatable structure at least partially axiallyoverlaps the second gear of at least one of; the first and second gearsystem, such that at least one of; the first and second gear system isat least partially placed inside of the electrical motor.

The first and second gears of the second gear system may in oneembodiment have a larger diameter than the rotatable structure, and areat least partially placed in the same axial plane, such that the firstand second gears of the second gear system at least partially axiallyoverlaps the rotatable structure, such that the electrical motor is atleast partially placed inside the second gear system.

The operable implant could further comprise a radially extendingconnecting structure directly or indirectly connecting the first gear ofthe first gear system to the operable element of the second gear system,to transfer force from the first gear system to the second gear system.

The first gear system could comprise a third gear, and the inside of thethird gear could comprise the same amount of teeth as the outside of thefirst gear, and the teeth of the third gear could be adapted tointerengage with the teeth of the third gear such that the third gearrotates in relation to the second gear, along with the angularly spacedpositions.

According to one embodiment, the first gear of the first gear systemindirectly connects with the operable element of the second gear systemvia the third gear of embodiment.

The rotatable structure may in any of the embodiments be placed radiallyon the inside of the circularly distributed coils.

The rotatable structure could be placed radially on the outside of thecircularly distributed coils.

The coils could in any one of the embodiment remain enclosed duringoperation of the operation device.

The first gear of at least one of; the first and second gear systemcould directly or indirectly connect to a threaded member adapted totransform the radially rotating force to an axially reciprocating force.The threaded member could be directly or indirectly connected to amovable wall portion of a reservoir.

In any one of the embodiments herein, the operable implant couldcomprise at least one fixation portion for fixating at least a part ofthe operable implant to at least one of fibrosis, a fascia and amuscular layer towards the inside of the subcutaneous space of thepatient.

The operable implant may further comprise a separate unit comprising areceiving unit adapted to receive wireless energy transmitted fromoutside the body.

The operable implant may further comprise a first reservoir in fluidconnection with the body engaging portion being hydraulically operable.The operation device may be adapted to cause transportation of fluidfrom the first reservoir to the hydraulically operable body engagingportion.

A portion of the wall of the reservoir could comprise at least one of: abellows structure, a shape adapted to allow movement although coveredwith fibrosis and a plate shaped surface, in all cases enabling movementof the at least one movable wall portion, enabling the compressionand/or expansion of the reservoir.

According to one embodiment, the operation device comprises a hydraulicpump for transporting the fluid from the first reservoir to thehydraulically operable body engaging portion. The hydraulic pump couldbe a hydraulic pump selected from: at least one reservoir with a wallmoving by the mechanical work acting as a pump, at least one reservoirchanging volume to move fluid acting as a pump, at least one non-valvepump, at least one valve pump, at least one peristaltic pump, at leastone membrane pump, at least one gear pump, and at least one bellowspump.

The electrical motor could be an electrical motor selected from: analternating current (AC) electrical motor, a direct current electricalmotor, a linear electrical motor, an axial electrical motor, apiezo-electric motor, a three-phase motor, a more than one-phase motor,a bimetal motor, and a memory metal motor.

The operation device may further comprise a first unit comprising: areceiving unit for receiving wireless energy, and a first gear systemadapted to receive mechanical work having a first force and firstvelocity, and output mechanical work having a different second force anda different second velocity, a second unit comprising an electricalmotor adapted to transform electrical energy into the mechanical work,and a distance element comprising: a lead for transferring theelectrical energy from the first unit to the second unit, and amechanical transferring member adapted to transfer the mechanical workfrom the electrical motor in the second unit to the gear system in thefirst unit, wherein the distance element is adapted to separate thefirst and second units such that the receiving unit, when receivingwireless energy, is not substantially affected by the second unit.

According to one embodiment, the second unit comprises a second gearsystem adapted to receive the mechanical work output from the first gearsystem with the different second force and the different second velocityas input, and output mechanical work having a third different force andthird different velocity, and wherein the gear system of the second unitis connected in series with the gear system of the first unit, via themechanical transferring member of the distance element.

The first unit could comprise a second gear system adapted receivemechanical work of a first force and velocity as input, and outputmechanical work having a different force and velocity. The second gearsystem may be connected in series with the first gear system.

The first unit of the operable implant may be adapted to be placed atleast in one of the following places: subcutaneously, subcutaneously inthe abdominal wall and in the abdomen.

The motor could comprise magnetic material and the first unit could beadapted to be substantially unaffected or not importantly affected bythe magnetic material in the second unit, during wirelessly energytransfer.

The first unit may comprise a reservoir for supplying fluid to the bodyengaging portion being hydraulically operable.

The first unit could comprise hydraulic pump adapted to transfermechanical work into hydraulic power for powering a hydraulicallyoperable body engaging portion, wherein the hydraulic pump is connectedto the force output of the first or second gear system.

The operable implant may further comprise a gear system comprising: anoperable element, a first gear having the shape of a hollow cylinder,comprising a first number of teeth, on the peripheral outside thereof,and a second gear having the shape of a hollow cylinder, comprising agreater number of teeth than the first gear, on the inside surfacethereof, wherein the operable element is adapted to engage the inside ofthe first gear, such that the outside of the first gear is pressedagainst the inside of the second gear such that the teeth of the firstgear are interengaged with the teeth of the second gear in at least oneposition interspaced by positions at which the teeth are notinterengaged, and wherein the operation of the operable element advancesthe positions and thereby causes relative rotation between the firstgear and the second gear, wherein the gear system and the axialelectrical motor are positioned coaxially, along the rotational axis ofelectrical motor.

According to one embodiment, the operable element comprises at least oneof a planet gear, and a structure or wheel at least partly usingfriction to interconnect with the first gear.

The first set of coils circularly distributed around a rotational axisof the electrical motor may be positioned on a magnetizable corestructure, and the radially extending rotatable structure may comprise arotatable disc, wherein a surface part of the magnetizable corestructure and the rotatable disc are positioned coaxially and therotatable disc is connected to a driving shaft connected to the operableelement.

The operation device may in one embodiment comprise an electrical motorhaving a force outlet, a gear system connected to the force outlet ofthe electrical motor, the gear system comprising: an operable element, afirst gear having the shape of a hollow cylinder, comprising a firstnumber of teeth, on the peripheral outside thereof, and a second gearhaving the shape of a hollow cylinder, comprising a greater number ofteeth than the first gear, on the inside surface thereof, wherein theoperable element is adapted to engage the inside of the first gear, suchthat the outside of the first gear is pressed against the inside of thesecond gear such that the teeth of the first gear are interengaged withthe teeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged. The operation of theoperable element advances the positions and thereby causes relativerotation between the first gear and the second gear, and a gear systemforce outlet connected to the first gear of the gear system and adaptedfor supplying force directly or indirectly to the body engaging portion,the gear system force outlet comprises a magnetic force coupling formagnetically, directly or indirectly, connecting to the body engagingportion for supplying force, and an enclosure for hermetically enclosingthe operation device.

According to one embodiment, the magnetic force coupling comprises aninside rotating structure placed inside the enclosure comprising atleast one magnet or a portion comprising magnetic or magnetizablematerial. The magnet or portion comprising magnetic or magnetizablematerial may be adapted to rotate to transfer force to a correspondingrotating structure on the outside of the hermetic enclosure, fordirectly or indirectly supplying force to the body engaging portionthrough the sealed enclosure.

The operable implant may according to one embodiment further comprisethe corresponding rotating structure on the outside of the hermeticenclosure, for directly or indirectly supplying force directly orindirectly to the body engaging portion.

According to one embodiment, the operable implant further comprises areservoir for holding a hydraulic fluid. The reservoir comprises amovable wall portion adapted to change the volume of the reservoir, themovable wall portion could be directly or indirectly connected to thegear system force outlet, such that operation of the electrical motor,via the gear system changes the volume of the reservoir.

According to one embodiment, the operable implant further comprises acorresponding rotating structure on the outside of the hermeticenclosure. The corresponding rotating structure directly or indirectlyconnects to a threaded member adapted to transform the radially rotatingforce to an axially reciprocating force.

The threaded member may in any of the embodiments herein be directly orindirectly connected to the movable wall of the reservoir for changingthe volume of the reservoir.

The operable implant may further comprise a peristaltic pump, and theperistaltic pump may comprise a hollow member for fluid transportation,and an operable compression member adapted to engage and compress thehollow member. The gear system force outlet via the magnetic couplingconnects to the compression member, such that the operation of theelectrical motor, via the gear system, operates the compression member,such that fluid is transported in the hollow member.

According to one embodiment, the operation device further comprises acontrol unit for controlling at least one of the operation device andthe body engaging portion, and the enclosure is adapted to enclose theoperation device including the control unit.

The operation device of the operable implant further comprises at leastone receiving unit adapted to receive wireless energy supplied fromoutside the body of the patient, wherein the receiving unit is placedseparate from the operation device, wherein the enclosure is adapted toinclude both the operation device, a distance element connecting theoperation device and the receiving unit and the receiving unit.

The distance element of the operable implant is adapted to create adistance between the wireless energy receiver and at least one of theelectrical motor and the magnetic coupling, such that the wirelessenergy receiver remains substantially unaffected or not importantlyaffected by metallic and/or magnetic components of the electrical motorand the magnetic coupling.

The receiving unit further comprises at least one coil adapted totransform wireless energy received in form of a magnetic, electric orelectromagnetic field into electrical energy.

The electrical motor of the operable implant could be an axialelectrical motor comprising: a plurality of coils, circularlydistributed around a rotational axis of the electrical motor such thatthe center axis of the helix of the coils are extending in the axialdirection of the electrical motor, parallel to the rotational axis ofthe electrical motor, and magnets, circularly distributed on a radiallyextending rotatable structure, on which the magnets are circularlydistributed around the rotational axis, the magnets in axial directionfacing the coils, such that the magnets at least partially radiallyoverlaps the coils, such that sequential energizing of the coilsmagnetically axially propels the magnets and causes rotation of therotatable structure around the rotational axis of the electrical motor.

In one embodiment, the electrical motor is a radial electrical motor,comprising: a plurality of coils circularly distributed around arotational axis of the implantable electrical motor, such that thecenter axis of the helix of the coils are extending in the radialdirection of the implantable electrical motor, substantiallyperpendicular to the rotational axis of the motor, and a plurality ofmagnets, circularly distributed on an axially extending rotatablestructure on which the magnets are circularly distributed around therotational axis, the magnets in radial direction facing the coils, suchthat the magnets at least partially axially overlaps the coils, suchthat sequential energizing of the coils magnetically propels the magnetsand causes rotation of the rotatable structure around the rotationalaxis of the electrical motor.

The electrical motor in any of the embodiment may be a linear electricalmotor in which the coils are linearly distributed along a direction ofmovement of a movable part of the linear electrical motor, and themovable part comprises linearly distributed magnets along a direction ofmovement of the movable part, such that sequential energizing of thecoils magnetically propels the magnets and causes linear movement of themovable part.

The electrical motor of the operation device could be an alternatingcurrent (AC) electrical motor, and the control unit could comprise afrequency converter for altering the frequency of an alternating currentfor controlling the alternating current electrical motor.

According to one embodiment, the enclosure may comprise a materialselected from: a carbon material, a boron material, a mixture ofmaterial, a Peek® material, an alloy of material, a metallic material,titanium, aluminum, a ceramic material, a polymer material,polyurethane, polyether ether ketone, silicone, and Parylene® coatedsilicone.

The operation device could comprise a hydraulic pump for transportinghydraulic fluid from a reservoir to the body engaging portion beinghydraulically operable.

According to one embodiment, the electrical motor comprises anelectrical motor selected from: an alternating current (AC) electricalmotor, a direct current electrical motor, a linear electrical motor, anaxial electrical motor, a piezo-electric motor, a three-phase motor, amore than one-phase motor, a bimetal motor, and a memory metal motor.

The electrical motor may be adapted to drive a comprised hydraulic pumpselected from: at least one reservoir with a wall moving by themechanical work acting as a pump, at least one reservoir changing volumeto move fluid acting as a pump, at least one non-valve pump, at leastone valve pump, at least one peristaltic pump, at least one membranepump, at least one gear pump, and at least one bellows pump.

According to one embodiment, the electrical motor comprises: a set ofcoils circularly distributed around a rotational axis of the electricalmotor, a set of magnets connected to a rotatable structure at leastpartially axially overlapping said coils, such that sequentialenergizing of said coils magnetically propels the magnets and causes therotatable structure to rotate around the rotational axis. The secondgear has a smaller diameter than the rotatable structure and is at leastpartially placed in the same axial plane, such that the rotatablestructure at least partially axially overlaps the second gear, such thatthe gear system is at least partially placed inside of the electricalmotor.

According to one embodiment, the operable element is adapted to deflectthe first gear, and to maintain the first gear deflected such that theteeth of the first gear are interengaged with the teeth of the secondgear in at least one of; one position, two positions, three positions,and four or more positions, wherein the two, three and four positionsare angularly spaced positions interspaced by positions at which theteeth are not interengaged.

The operable element may be adapted to deflect the first gear, and tomaintain the first gear deflected such that the teeth of the first gearare interengaged with the teeth of the second gear in at least twoangularly spaced positions interspaced by positions at which the teethare not interengaged.

The operation device may further comprise a second gear systemcomprising: an operable element, a first gear having the shape of ahollow cylinder, comprising a first number of teeth, on the peripheraloutside thereof, and a second gear having the shape of a hollowcylinder, comprising a greater number of teeth than the first gear, onthe inside surface thereof, wherein the operable element is adapted toengage the inside of the first gear, such that the outside of the firstgear is pressed against the inside of the second gear such that theteeth of the first gear are interengaged with the teeth of the secondgear in at least one position interspaced by positions at which theteeth are not interengaged, and wherein the operation of the operableelement advances the positions and thereby causes relative rotationbetween the first gear and the second gear. The first gear of the firstgear system is directly or indirectly connected to the operable elementof the second gear system, such that the first gear system is connectedin series with the second gear system, such that the first gear systemreceives mechanical work having a first force and first velocity andoutputs mechanical work having a second, different, force and a second,different, velocity, and the second gear system receives the outputmechanical work from the first gear system, as input, and outputsmechanical work with a third different force and third differentvelocity.

The first and second gear systems may be positioned coaxially, along therotational axis of the first and second gear systems.

According to one embodiment, the second gear of at least one of; thefirst and second gear system has a smaller diameter than the rotatablestructure and is at least partially placed in the same axial plane, suchthat the rotatable structure at least partially axially overlaps thesecond gear of at least one of; the first and second gear system, suchthat at least one of; the first and second gear system is at leastpartially placed inside of the electrical motor.

The first and second gears of the second gear system may have a largerdiameter than the rotatable structure and be at least partially placedin the same axial plane, such that the first and second gears of thesecond gear system at least partially axially overlaps the rotatablestructure, such that the electrical motor is at least partially placedinside the second gear system.

The operable implant may further comprise a radially extendingconnecting structure directly or indirectly connecting the first gear ofthe first gear system to the operable element of the second gear system,for transferring force from the first gear system to the second gearsystem.

The first gear system may comprise a third gear, and wherein the insideof the third gear may comprise the same amount of teeth as the outsideof the first gear. The teeth of the third gear may be adapted tointerengage with the teeth of the first gear such that the third gearrotates in relation to the second gear, along with the angularly spacedpositions.

The first gear of the first gear system could be adapted to indirectlyconnect with the operable element of the second gear system via thethird gear.

The rotatable structure of any of the embodiments may be placed radiallyon the inside or outside of the circularly distributed coils.

The coils of the operable implant may be adapted to remain enclosedduring operation of the operation device.

According to one embodiment, the first gear of at least one of; thefirst and second gear system directly or indirectly connects to athreaded member adapted to transform the radially rotating force to anaxially reciprocating force. The threaded member may be directly orindirectly connected to a movable wall portion of the reservoir.

The operable implant may further comprise at least one fixation portionfor fixating at least a part of the operable implant to at least one offibrosis, a fascia and a muscular layer towards the inside of thesubcutaneous space of the patient.

According to one embodiment, the first reservoir is in fluid connectionwith the body engaging portion being hydraulically operable, and whereinthe operation device, is adapted to cause: transportation of fluid fromthe first reservoir to the hydraulically operable body engaging portion.

A portion of the wall of the reservoir may comprise at least one of: abellows structure, a shape adapted to allowing movement although coveredwith fibrosis and a plate shaped surface, in all cases enabling movementof the at least one movable wall portion, enabling the compressionand/or expansion of the reservoir.

An operable implant may comprising an operation device and a bodyengaging portion is further provided. The operation device comprises: anelectrical motor having a force output, and a start resistance delaymember positioned between the force output of the electrical motor andthe body engaging portion, wherein the start resistance delay member isadapted to enable the electrical motor to operate with at least one of;less force or less friction induced by the direct or indirect connectionwith the body engaging portion for a time period, such that theelectrical motor can start with less resistance.

The force output of the electrical motor could according to oneembodiment be directly or indirectly connected to a force input of agear system. The gear system may comprise: an operable element, a firstgear having the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof, wherein the operableelement is adapted to engage the inside of the first gear, such that theoutside of the first gear is pressed against the inside of the secondgear such that the teeth of the first gear are interengaged with theteeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear, andwherein the gear system comprises a force output connected to the firstgear.

In any of the embodiments, operable implant may further comprise asecond gear system positioned between the first gear system and thestart resistance delay. The second gear system could comprise a forceinput connected to an operable element, directly or indirectly connectedto the force output of the first gear system, a first gear having theshape of a hollow cylinder, comprising a first number of teeth, on theperipheral outside thereof, and a second gear having the shape of ahollow cylinder, comprising a greater number of teeth than the firstgear, on the inside surface thereof, wherein the operable element isadapted to engage the inside of the first gear, such that the outside ofthe first gear is pressed against the inside of the second gear suchthat the teeth of the first gear are interengaged with the teeth of thesecond gear in at least one position interspaced by positions at whichthe teeth are not interengaged, and wherein the operation of theoperable element advances the positions and thereby causes relativerotation between the first gear and the second gear, and wherein thesecond gear system comprises a force output connected to the first gearof the second gear system.

The start resistance delay member could be positioned between the forceoutput of the electrical motor and the force input of the gear system orbetween the force output of the gear system and the body engagingportion.

In alternative embodiments, the start resistance delay member ispositioned one of: between the force output of the first gear system andthe force input of the second gear systems, and between the force outputof the second gear system and the body engaging portion.

According to one embodiment, the start resistance delay member comprisesa spring, which could be a helical spring or a leaf spring.

In alternative embodiments, the start resistance delay member comprise amechanical play, which could be one of a radial mechanical play and alinear mechanical play.

The start resistance delay member could comprise a radial mechanicalplay enabling the force output of the electrical motor to perform atleast one of: 1/10 of a revolution, ⅛ of a revolution, ⅙ of arevolution, ¼ of a revolution, ½ of a revolution and 1 revolution,before the force output directly or indirectly engages the drivingmember.

According to one embodiment, the start resistance delay member ispositioned between one of: the force output of the first gear system,and the force input of the second gear system, and the force output ofthe second gear system, and the body engaging portion. The startresistance delay could comprise a radial mechanical play enabling theforce output of the gear system to perform at least one of: 1/10 of arevolution, ⅛ of a revolution, ⅙ of a revolution, ¼ of a revolution, ½of a revolution and 1 revolution, before the force output engages thedriving member, such that the force output of the electrical motor canperform at least one of 1/10 of a revolution*the transmission of thegear system, ⅛ of a revolution*the transmission of the gear system, ⅙ ofa revolution*the transmission of the gear system, ¼ of a revolution*thetransmission of the gear system, ½ of a revolution*the transmission ofthe gear system and 1 revolution*the transmission of the gear system.

In alternative embodiments, the start resistance delay device maycomprise a friction clutch.

In yet alternative embodiments, the start resistance delay device maycomprise at least one element adapted to be operated by centrifugalforce. The at least one element could be connected to the electricalmotor and adapted to engage, directly or indirectly, the body engagingportion when the centrifugal force exerted on the element exceeds acentrifugal delay force.

According to one embodiment, the operable element of the first and/orsecond gear system could comprise an element adapted to be operated bycentrifugal force, such that the operable element of the gear systemengages the first gear when the centrifugal force exerted on the elementexceeds the centrifugal delay force.

The electrical motor could be an electrical motor selected from: analternating current (AC) electrical motor, a direct current electricalmotor, a linear electrical motor, an axial electrical motor, apiezo-electric motor, a three-phase motor, a more than one-phase motor,a bimetal motor, and a memory metal motor.

According to one embodiment, the body engaging portion is ahydraulically operable body engaging portion connected to a hydraulicpump for transporting hydraulic fluid for operating the hydraulicallyoperable body engaging portion. The hydraulic pump could comprise areservoir comprising at least one movable wall portion, and the at leastone movable wall portion could be in direct or indirect connection withthe electrical motor, such that the electrical motor is arranged tooperate the movable wall portion for changing the volume of thereservoir.

According to one embodiment, the force output of the electrical motordirectly or indirectly connects to a threaded member adapted totransform a radially rotating force of the electrical motor to anaxially reciprocating force. The threaded member could be directly orindirectly connected to the movable wall portion of the reservoir forchanging the volume of the reservoir.

According to one embodiment of the operable implant, the threaded memberis directly or indirectly connected to a movable wall portion of asecond reservoir for changing the volume of the second reservoir.

The movement of the movable wall portion of the first reservoir by thethreaded member in a first direction could cause the first fluidreservoir to expand and the volume in the first reservoir to increase.The movement of the movable wall portion of the second reservoir by thethreaded member in a first direction causes the second reservoir tocontract and the volume in the second reservoir to decrease.

According to one embodiment, the first reservoir is in fluid connectionwith a first hydraulically operable body engaging portion, and thesecond reservoir is in fluid connection with a second hydraulicallyoperable body engaging portion. Operation of the electrical motor in afirst direction, by the connection with the threaded member, causes:transportation of fluid from the first reservoir to the firsthydraulically operable implant, and transportation of fluid from thesecond hydraulic operable body engaging portion to the second fluidreservoir.

The reservoir could for example be circular or torus shaped. Accordingto one embodiment of the operable implant, the operable implantcomprises a circular reservoir encircling the operation device. Thecircular reservoir comprises a movable wall portion adapted to compressand expand the circular reservoir, thereby altering the volume of thereservoir, and the movable wall portion is connected to the electricalmotor, such that the operation of the electrical motor changes thevolume of the circular reservoir.

A portion of the wall of the reservoir could comprises at least one of;a bellows structure, a shape adapted to allowing movement althoughcovered with fibrosis and a plate shaped surface, in all cases enablingmovement of the at least one movable wall portion, enabling thecompression and/or expansion of the reservoir.

In one embodiment, the operable implant comprises a hydraulic pump,which could be a peristaltic pump comprising: a hollow member for fluidtransportation, and an operable compression member adapted to engage andcompress the hollow member, and wherein the electrical motor is indirect or indirect connection with the compression member, such that theoperation of the electrical machine operates the compression member suchthat fluid is transported in the hollow member.

An operable implant adapted to be implanted in the body of a patient isfurther provided. The operable implant comprises an operation device anda body engaging portion. The operation device comprises a first gearsystem comprising: an operable element, a first gear having the shape ofa hollow cylinder, comprising a first number of teeth, on the peripheraloutside thereof, and a second gear having the shape of a hollowcylinder, comprising a greater number of teeth than the first gear, onthe inside surface thereof. The operable element is adapted to engagethe inside of the first gear, such that the outside of the first gear ispressed against the inside of the second gear such that the teeth of thefirst gear are interengaged with the teeth of the second gear in atleast one position interspaced by positions at which the teeth are notinterengaged. The operation of the operable element advances theinterengaged positions and thereby causes relative rotation between thefirst gear and the second gear. The operation device further comprises asecond gear system comprising: an operable element, a first gear havingthe shape of a hollow cylinder, comprising a first number of teeth, onthe peripheral outside thereof, and a second gear having the shape of ahollow cylinder, comprising a greater number of teeth than the firstgear, on the inside surface thereof. The operable element is adapted toengage the inside of the first gear, such that the outside of the firstgear is pressed against the inside of the second gear such that theteeth of the first gear are interengaged with the teeth of the secondgear in at least one position interspaced by positions at which theteeth are not interengaged. The operation of the operable elementadvances the at least one position and thereby causes relative rotationbetween the first gear and the second gear.

The first gear of the first gear system is directly or indirectlyconnected to the operable element of the second gear system, such thatthe first and second gear systems functions as a single gear system.

According to one embodiment, the first gear of the first and second gearsystem comprises a deflectable wall. The operable element is adapted todeflect the first gear, and to maintain the first gear deflected suchthat the teeth of the first gear are interengaged with the teeth of thesecond gear in at least one angularly spaced positions interspaced bypositions in which the teeth are not interengaged. The operation of thepressing element rotatively advances the angularly spaced positions andthereby causes relative rotation between the first gear and the secondgear.

According to one embodiment, the operable element is adapted to deflectthe first gear, and to maintain the first gear deflected such that theteeth of the first gear are interengaged with the teeth of the secondgear in at least one of; at least two angularly spaced positions and atleast three angularly spaced positions, interspaced by positions atwhich the teeth are not interengaged.

In one embodiment of the operable implant, at least one of the first andsecond gear systems comprises a third gear having the shape of a hollowcylinder. The inside of the third gear comprises the same amount ofteeth as the outside of the first gear, and the teeth of the third gearare adapted to interengage the teeth of the first gear such that thethird gear rotates in relation to the second gear, along with the atleast one interengaged position.

According to one embodiment, the first gear system comprises a thirdgear having the shape of a hollow cylinder, and the inside of third gearcomprises the same amount of teeth as the outside of the first gear ofthe first gear system. The teeth of the third gear are adapted tointerengage the teeth of the first gear such that the third gear rotatesin relation to the second gear, along with the at least one interengagedposition, wherein the operable element of the second gear system isconnected directly or indirectly to the third gear of the first gearsystem.

The first gear could at least partially be positioned radially inside ofthe second gear system, such that the second gear system axially atleast partially overlaps the first gear system. In alternativeembodiments, the first and second gear systems could be positionedcoaxially, along the rotational axis of the first and second gearsystems.

According to one embodiment, the operable implant further comprises aradially extending connecting structure directly or indirectlyconnecting the first gear of the first gear system with the operableelement of the second gear system, to transfer force from the first gearsystem to the second gear system.

The operable implant according to any one of the preceding embodimentscould further comprise an enclosure adapted to hermetically enclose thefirst and second gear systems, such that the first and second gearsystems are sealed from bodily fluids when implanted.

The operable element of the first and second gear systems of any of theembodiments herein could further comprise at least one of; a planet gearand a structure or wheel comprising a frictional surface connection.

In one embodiment, the operable implant further comprises an electricalmotor. The electrical motor could comprise an electrical motor selectedfrom: an alternating current (AC) electrical motor, a direct currentelectrical motor, a linear electrical motor, an axial electrical motor,a piezo-electric motor, a three-phase motor, a more than one-phasemotor, a bimetal motor, and a memory metal motor.

The operable implant in any of the embodiments could further comprise anenclosure adapted to hermetically enclose the first gear system and theelectrical motor. The enclosure could comprise a sealed outlet forrotational force, such that the force can be transferred from thehermetically enclosed first gear system to the second gear system.

The operable implant in any of the embodiments could further comprise asystem enclosure adapted to hermetically enclose the first gear system,the second gear system and the electrical motor.

The operable implant may further comprise a sealed outlet for rotationalforce, such that the force can be transferred from the hermeticallyenclosed second gear system to an operable implant.

The operable implant may further comprise an enclosure adapted tohermetically enclose the electrical motor, which may comprise a sealedoutlet for rotational force, such that the force can be transferred fromthe hermetically enclosed motor to the first gear system.

The operable implant may further comprise an enclosure adapted tohermetically enclose the static part of the electrical motor, comprisingat least one of; at least two coils and at least one core.

According to one embodiment, the enclosure of the static part of themotor could comprise a wall, the operable implant could be adapted tocreate rotational force from the hermetically enclosed static partwirelessly through the sealed wall, to create rotational force forrotating a rotor part of the motor, comprising at least one of; at leastone magnet, magnetizable material and at least one coil, the rotoradapted to directly or indirectly be further connected to the first gearsystem.

According to one embodiment, the operable implant further comprises anenclosure adapted to hermetically enclose the rotor part of theelectrical motor and at least one of; the first gear system and thefirst and second gear system.

An operable implant adapted to be implanted in the body of a patient isfurther provided. The operable implant comprises an operation device anda body engaging portion. The operation device comprises: at least oneof; at least one magnet, at least one magnetic material and at least onemagnetizable material adapted to be affected by a moving magnetic fieldcreated by an external unit, when implanted, such that the magnet ormagnetic or magnetizable material moves along with the moving magneticfield of the external unit. The operation device further comprises agear system comprising: an operable element directly or indirectlyconnected to the at least one magnet, magnetic material, or magnetizablematerial, such that the operable element is propelled by the magnet ormagnetic material moving along with the moving magnetic field of theexternal unit, a first gear having the shape of a hollow cylinder,comprising a first number of teeth, on the peripheral outside thereof,and a second gear having the shape of a hollow cylinder, comprising agreater number of teeth than the first gear, on the inside surfacethereof. The operable element is adapted to engage the inside of thefirst gear, such that the outside of the first gear is pressed againstthe inside of the second gear such that the teeth of the first gear areinterengaged with the teeth of the second gear in at least one positioninterspaced by positions in which the teeth are not interengaged. Theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear.

The operation device of any of the embodiments herein may be adapted tobe implanted subcutaneously, which could be subcutaneously in theabdominal region.

In any of the embodiments, the operation device could comprise a firstunit and a second unit, and the at least one magnet, magnetic material,or magnetizable material is placed in the first unit, and the gearsystem is placed in the second unit.

The operable implant may further comprise a distance element adapted tocreate a distance between the first and second units. The distanceelement is adapted to be at least one of; placed through the muscularlayers of the abdominal wall, and fixated to the muscular fascia at theinner side of the subcutaneous space. The distance element could beflexible such that the first and second units can move in relation toeach other. The distance element could be adapted to be fixated to atleast one of; the fascia and muscular layer of the abdominal wall, suchthat the distance between the first portion of the operation device andthe skin of the patient can be controlled. The distance element couldcomprise a mechanical transferring member adapted to transfer force fromthe first unit to the second unit, such that force can be transferredfrom the at least one magnet, magnetic material, or magnetizablematerial to the operable element of the gear system.

In one embodiment, the operable implant further comprises an enclosureadapted to hermetically enclose at least one of; the operable implant,the operation device, the body engaging portion, the first unit, thesecond unit or the distance element, for sealing from the bodily fluidsof the patient.

In one embodiment, the enclosure constitutes a reservoir for supplyingfluid to a hydraulically operable body engaging portion, such that theat least one magnet, magnetic material, or magnetizable material andgear system is placed inside of the reservoir.

The operable implant could further comprise a reservoir comprising amovable wall portion adapted to change the volume of the reservoir,wherein the movable wall portion is directly or indirectly connected tothe first gear of the gear system, such that operation of the gearsystem changes the volume of the reservoir.

The first gear of the gear system could be directly or indirectlyconnected to a threaded member adapted to transform a rotating force toa reciprocating force.

The threaded member could be directly or indirectly connected to themovable wall portion of the reservoir for changing the volume of thereservoir.

The operable implant according to any one of the preceding embodimentscould further comprise a peristaltic pump. The peristaltic pumpcomprises a hollow member for fluid transportation, and an operablecompression member adapted to engage and compress the hollow member, andwherein first gear of the gear system is in direct or indirectconnection with the compression member, such that the operation of thegear system operates the compression member such that fluid istransported in the hollow member.

The operable implant in any of the preceding embodiments could furthercomprise a second gear system comprising: an operable element, a firstgear having the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof. The operable elementcould be adapted to engage the inside of the first gear, such that theoutside of the first gear is pressed against the inside of the secondgear such that the teeth of the first gear are interengaged with theteeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the at least one position andthereby causes relative rotation between the first gear and the secondgear, wherein the first gear of the first gear system is connected,directly or indirectly to the operable element of the second gearsystem, such that the first and second gear systems functions as asingle gear system.

The operable element of one of the first and second gear systems couldcomprise at least one of; a planet gear and a structure or wheel atleast partly using friction to enable rotating force to be transported.

The operable implant in any of the preceding embodiments could furthercomprise a wireless communication unit adapted to at least one of:receive wireless communication signals from an external unit, andtransmit wireless communication signals to an external unit.

An external unit for supplying force to an implanted operation device isfurther provided. The external unit comprises: an external drive unitadapted to create a moving magnetic field on the outside of thepatient's skin adapted to affect at least one magnet or magneticmaterial or magnetizable material of an implanted operation device, suchthat the magnet or magnetic material moves along with the movingmagnetic field of the external drive unit.

The external drive unit could further comprise a set of coils circularlydistributed around a rotational axis of the external unit, such thatsequential energizing of the coils creates a rotating magnetic fieldadapted to affect the magnet or magnetic material or magnetizablematerial of the implanted operation device, such that the magnet ormagnetic material moves along with the moving magnetic field of theexternal drive unit.

The external drive unit could further comprise a rotatable structurecomprising at least one magnet or magnetic material, and the rotatablestructure could affect the magnet or magnetic material or magnetizablematerial of the implanted operation device to cause rotation thereof,such that the magnet or magnetic material or magnetizable materialrotates along with the rotatable structure of the external unit.

According to one embodiment, the external unit further comprises awireless communication unit adapted to at least one of: receive wirelesscommunication signals from an implantable unit, and transmit wirelesscommunication signals to an implantable unit.

A medical system is further provided. The medical system comprises anoperable implant according to any one of the embodiments herein, and anexternal unit according to any one of the embodiments herein.

In one of the embodiments, the operation device comprises a rotatablestructure adapted to hold at least one of; at least one magnet, at leastone magnetic material and at least one magnetizable material, andfurther adapted to be affected by the moving externally created magneticfield, such that the rotatable structure rotates.

The operable implant could further comprise an enclosure adapted tohermetically enclose at least one of; the rotational structure accordingto any of the embodiments, the reservoir according to any of theembodiments, and the treaded member according to any of the embodiments,for sealing from the bodily fluids of the patient.

In any of the preceding embodiments, the operation device could comprisea reservoir adapted to contain a hydraulic fluid and at least onemovable wall portion for changing the volume of the reservoir. Theoperation device is adapted to operate the movable wall of thereservoir, wherein the operation device comprises a gear system placedwithin the reservoir, the gear system comprising: an operable element, afirst gear having the shape of a hollow cylinder, comprising a firstnumber of teeth, on the peripheral outside thereof, and a second gearhaving the shape of a hollow cylinder, comprising a greater number ofteeth than the first gear, on the inside surface thereof, wherein theoperable element is adapted to engage the inside of the first gear, suchthat the outside of the first gear is pressed against the inside of thesecond gear such that the teeth of the first gear are interengaged withthe teeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear.

An operable implant adapted to be implanted in the body of a patient isfurther provided. The operable implant comprises a hydraulic operationdevice for supplying hydraulic force and a body engaging portion adaptedto receive the hydraulic force. The hydraulic operation device comprisesa reservoir adapted to contain a hydraulic fluid, the reservoircomprises at least one movable wall portion for changing the volume ofthe reservoir, and an operation device adapted to operate the movablewall. The operation device comprises a gear system placed within thereservoir, the gear system comprising: an operable element, a first gearhaving the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof, wherein the operableelement is adapted to engage the inside of the first gear, such that theoutside of the first gear is pressed against the inside of the secondgear such that the teeth of the first gear are interengaged with theteeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear.

The first gear of the operable implant directly or indirectly connectsto a threaded member adapted to transform a rotating force to areciprocating force.

The threaded member could directly or indirectly be connected to themovable wall portion of the reservoir such that operation of theoperation device changes the volume of the reservoir.

The operable implant according to any one of the embodiments, couldfurther comprise a rotatable structure positioned on the inside of thereservoir and connected to the operable element of the gear system, therotatable structure comprising at least one magnet, at least onemagnetic material or at least one magnetizable material adapted to be inmagnetic connection with a rotating magnetic field outside of thereservoir, such that the rotating magnetic field on the outside of thereservoir propels the rotatable structure inside of the reservoir.

The rotatable structure of the operable implant could comprise aradially extending disc comprising a plurality of magnets, and theplurality of magnets could be adapted to axially be in magneticconnection with the rotating magnetic field.

According to one embodiment, the operable implant further comprises adrive unit comprising a plurality of axially positioned coils circularlydistributed around a rotational axis of the rotatable structurepositioned on the inside of the reservoir, such that the center axis ofthe helix of the coils extends in the axial direction, substantiallyparallel or substantially aligned in the center of the rotational axisof the rotatable structure, and wherein sequential energizing of thecoils creates the rotating magnetic field axially propelling therotatable structure.

The operable implant could further comprise a magnetic couplingcomprising a driving rotatable structure comprising a plurality ofmagnets circularly distributed around a rotational axis of the rotatablestructure. The driving rotatable structure could be adapted to be inmagnetic connection with the rotatable structure positioned on theinside of the reservoir, and the driving rotatable structure isconnected to an electrical motor adapted to propel the driving rotatablestructure such that the rotatable structure positioned on the inside ofthe reservoir rotates along with the driving rotatable structure.

The rotatable structure could comprise an axially extending cylindercomprising a plurality of magnets positioned on the peripheral surfaceof the cylinder, and wherein the plurality of magnets are adapted toradially be in magnetic connection with the rotating magnetic field.

The operable implant could further comprise a drive unit comprising aplurality of radially positioned coils circularly distributed around arotational axis of the rotatable structure positioned on the inside ofthe reservoir, such that the center axis of the helix of the coils areextending in the radial direction, substantially perpendicular to therotational axis of the rotatable structure, and wherein sequentialenergizing of the coils creates the rotating magnetic field propellingthe rotatable structure.

The operable implant may further comprise a drive unit comprising adriving rotatable structure comprising a plurality of magnets circularlydistributed around a rotational axis of the rotatable structure. Thedriving rotatable structure could be adapted to radially be in magneticconnection with the rotatable structure positioned on the inside of thereservoir, and the driving rotatable structure could be connected to anelectrical motor adapted to propel the driving rotatable structure suchthat the rotatable structure positioned on the inside of the reservoirrotates along with the driving rotatable structure, adapted to rotateradially on the outside thereof.

According to one embodiment, the drive unit is an external drive unitadapted to be positioned on the outside of the skin of the patient andpropel the rotatable structure in the hydraulic operation device.

According to one embodiment, the hydraulic operation device comprises anelectrical motor adapted to propel the operable element of the gearsystem. The electrical motor could be an electrical motor selected from:an alternating current (AC) electrical motor, a direct currentelectrical motor, a linear electrical motor, an axial electrical motor,a radial motor, a three phase motor, a more than one phase motor, apiezo-electric motor, a bimetal motor, and a memory metal motor.

The electrical motor could be adapted to be positioned on the inside ofthe reservoir.

The operable implant according to any one of the preceding embodimentscould further comprise a force transferring member, adapted to at leastone of; penetrating a wall of the fluid reservoir, not penetrating awall of the reservoir, transferring force from outside of the reservoirto inside of the reservoir, and transferring force between the motor andgear system inside the reservoir.

The force transferring member could be connected to an implantableelectrical motor and to the operable element of the gear system andadapted to transfer rotational force from the electrical motor to theoperable element.

The operable implant could further comprise a second gear systemcomprising: an operable element, a first gear having the shape of ahollow cylinder, comprising a first number of teeth, on the peripheraloutside thereof, and a second gear having the shape of a hollowcylinder, comprising a greater number of teeth than the first gear, onthe inside surface thereof, wherein the operable element is adapted toengage the inside of the first gear, such that the outside of the firstgear is pressed against the inside of the second gear such that theteeth of the first gear are interengaged with the teeth of the secondgear in at least one position interspaced by positions at which theteeth are not interengaged, and wherein the operation of the operableelement advances the at least one position and thereby causes relativerotation between the first gear and the second gear. The first gear ofthe first gear system could be connected to the operable element of thesecond gear system, such that the first and second gear systemsfunctions as a single gear system.

According to one embodiment, the operable element of at least one of thefirst and second gear systems comprises at least one of; a planet gearand a wheel or structure adapted to use frictional connection direct orindirect between the operable element and the first gear.

The hydraulic operation device further comprises at least one receivingunit adapted to receive wireless energy supplied from outside the bodyof the patient.

The receiving unit of the operable implant comprises at least one coiladapted to transform wireless energy received in form of a magnetic orelectromagnetic field into electrical energy.

The operable implant could further comprise a distance element adaptedto create a distance between the receiving unit and at least one of; thereservoir and the electrical motor, such that the receiving unit remainssubstantially unaffected by metallic and/or magnetic parts of thereservoir and/or electrical motor. The distance element is adapted to atleast one of; be placed through the muscular layers of the abdominalwall and be fixated to the fascia of a muscle facing the inside of thesubcutaneous space.

According to one embodiment, the distance element is flexible such thatthe wireless energy receiver can move in relation to the reservoirand/or electrical motor. The distance element could be adapted to befixated to at least one muscular layer of the abdominal wall, such thatat least one of; the distance between the first portion of theimplantable unit and the skin of the patient can be controlled and themovement of the distance element including rotation is minimized.

The operable implant could further comprise an injection port fordirectly or indirectly supplying fluid to the reservoir or the operableimplant, being hydraulically operated.

An implantable electrical generator for transforming mechanical work toelectrical energy is further provided. The implantable electricalgenerator comprises a movable structure comprising at least one magnetor at least one magnetic material or at least one magnetizable material,the movable structure being adapted to be in magnetic connection with anexternal drive unit creating a moving magnetic field, such that themovable structure moves along with the moving magnetic field. Theimplantable electrical generator further comprises an electricalgenerator unit connected to the movable structure and being adapted totransform the movements of the movable structure to electrical energy.

The electrical generator unit comprises: a movable generator portioncomprising at least one magnet. The movable generator portion isconnected to the movable structure, and at least one coil in magneticconnection with the at least one magnet, the electrical current isinduced in the coil by the movement of the movable generator portion inrelation to the coil.

According to one embodiment, the movable structure comprises a rotatabledisc, and the at least one magnet or magnetic material is positioned onthe rotatable disc and adapted to be in magnetic connection with anexternal unit creating a rotating magnetic field. The electricalgenerator unit is a rotating electrical generator unit connected to therotatable disc, such that the rotating electrical generator unit rotatesalong with, or is part of, the rotatable disc for inducing electricalcurrent.

The movable structure is adapted to perform reciprocating movement, andthe movable structure is adapted to be in magnetic connection with anexternal unit creating a reciprocating magnetic field, such that themovable structure performs reciprocating movement along with thereciprocating magnetic field.

According to one embodiment, the movable structure is connected to anelastic element or spring, such that the movable structure can operatein a first direction by the magnetic force supplied by the externalunit, and in a second direction by the elastic element or spring.

The elastic element could comprise at least one of; an elastic material,a flexible material, a construction adapted to create elastic movement,and a spring.

The electrical generator unit could in one embodiment be a linearelectrical generator unit comprising: a movable generator portioncomprising at least one magnet, wherein the movable generator portion isin connection with the movable structure adapted to performreciprocating movement, and at least one coil in magnetic connectionwith the at least one magnet, such that reciprocating movement of themovable structure propagates to the movable generator portion andinduces current in the at least one coil.

According to one embodiment, the implantable electrical generatorfurther comprises a battery connected to the electrical generator unit,wherein the battery is adapted to store electrical energy generated inthe generator unit.

The implantable electrical generator could further comprise an enclosureadapted to hermetically enclose the implantable electrical generator,such that the implantable electrical generator is sealed from the bodilyfluids of the patient.

The implantable electrical generator could further comprise a wirelesscommunication unit adapted to at least one of: receive wirelesscommunication signals from an external unit, and transmit wirelesscommunication signals to an external unit.

The implantable electrical generator could be adapted to be implantedsubcutaneously, which could be subcutaneously in the abdomen.

An external unit for supplying force to an implantable electricalgenerator is further provided. The external unit comprises an externaldrive unit adapted to create a moving magnetic field on the outside ofthe patient's skin adapted to affect at least one magnet or at least onemagnetic material or at least one magnetizable material of animplantable electrical generator, such that the magnet or magneticmaterial moves along with the moving magnetic field of the externaldrive unit.

According to one embodiment, the external drive unit comprises at leastone an electro magnet adapted to be alternatingly energized and notenergized, such that an alternating magnetic field is created foraffecting at least one magnet or magnetic material of the implantableelectrical generator.

The external drive unit could comprise at least one permanent magnet,and a positive pole of the permanent magnet is adapted to affect apermanent magnet of the implantable generator, and a negative pole ofthe permanent magnet could be adapted to affect the permanent magnet ofthe implantable generator. At least one permanent magnet could beadapted to move such that the positive and negative pole alternatinglyaffects the permanent magnet of the implantable generator.

According to one embodiment, the external drive unit comprises a set ofcircularly distributed coils, such that sequential energizing of thecoils creates a rotating magnetic field adapted to affect the magnet,magnetic material, or magnetizable material of the implantableelectrical generator, such that the magnet, magnetic material, ormagnetizable material rotates along with the rotating magnetic field ofthe external drive unit.

In one embodiment, the external unit comprises a set of linearlydistributed coils, such that sequential energizing of the coils createsa linearly moving magnetic field adapted to affect the magnet ormagnetic material or magnetizable material of the implantable electricalgenerator, such that the magnet, magnetic material, or magnetizablematerial moves along with the linear magnetic field of the externalunit.

The external unit could comprise a rotatable structure comprising atleast one magnet or magnetic material, and rotation of the rotatablestructure could affect a magnet or magnetic material of the implantableelectrical generator causing rotation thereof, such that the magnet ormagnetic material rotates along with the rotatable structure of theexternal unit.

The external unit could comprise a reciprocating structure comprising atleast one of: magnetic material, a permanent magnet, and anelectromagnet. The reciprocating structure could be adapted to move themagnetic material, permanent magnet or electromagnet between a firstposition close to the skin of the patient, and a second position furtherfrom the skin of the patient, such that a reciprocating magnetic fieldadapted to affect the magnet or magnetic material of the implantableelectrical generator is created, or be adapted to intermittently receiveelectric pulses to the at least one electromagnet to cause movement ofthe magnetic field, while the reciprocating structure substantiallystands still.

According to one embodiment, the external unit further comprises awireless communication unit adapted to at least one of: receive wirelesscommunication signals from the implantable electrical generator, andtransmit wireless communication signals to the implantable electricalgenerator.

A system for generating electrical current inside of the body of apatient is further provided. The system comprises: an implantableelectrical generator according to any one of the embodiments herein, andan external unit according to any one of the embodiments herein.

An operable hydraulic implant comprising a hydraulic operation device isfurther provided. The hydraulic operation device comprises an enclosureadapted to hermetically enclose: a reservoir adapted to contain ahydraulic fluid for operating the operable hydraulic implant, and a gearsystem adapted receive mechanical work of a first force and velocity asinput, and output mechanical work having a different force and velocity.The reservoir and the gear system are sealed from the bodily fluids whenimplanted.

The reservoir could comprise at least one movable wall portion, forchanging the volume of the reservoir.

In one embodiment, the gear system is connected to the movable wall forchanging the volume of the reservoir. In one embodiment, the operablehydraulic implant further comprises an electrical motor connected to thegear system and enclosed by the enclosure.

In one of the embodiments herein, the gear system comprises: an operableelement, a first gear having the shape of a hollow cylinder, comprisinga first number of teeth, on the peripheral outside thereof, and a secondgear having the shape of a hollow cylinder, comprising a greater numberof teeth than the first gear, on the inside surface thereof, wherein theoperable element is adapted to engage the inside of the first gear, suchthat the outside of the first gear is pressed against the inside of thesecond gear such that the teeth of the first gear are interengaged withthe teeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear.

In one embodiment of the operable hydraulic implant, the operableelement of the gear system is adapted to receive mechanical work of afirst force and velocity from the electrical motor. The first gear ofthe gear system is directly or indirectly connected to the at least onemovable wall portion for supplying mechanical work having a differentsecond force and velocity to the at least one wall portion, such thatoperation of the electrical motor moves the movable wall portion andchanges the volume of the reservoir.

In one embodiment, the first gear of the gear system directly orindirectly connects to a threaded member adapted to transform theradially rotating force to an axially reciprocating force, and whereinthe threaded member is directly or indirectly connected to the movablewall portion for changing the volume of the reservoir. The threadedmember could be directly or indirectly connected to a movable wallportion of a second fluid reservoir for changing the volume of thesecond reservoir.

The movement of the movable wall portion of the first reservoir, by thethreaded member in a first direction causes the first reservoir toexpand and the volume in the first reservoir to increase, and themovement of the movable wall portion of the second reservoir by thethreaded member in a first direction causes the second reservoir tocontract and the volume in the second reservoir to decrease.

The first reservoir could be in fluid connection with a firsthydraulically operable body engaging portion, and wherein the secondreservoir could be in fluid connection with a second hydraulicallyoperable body engaging portion, and operation of the electrical motorunit in a first direction, by the connection with the threaded member,could cause transportation of fluid from the first reservoir to thefirst hydraulically operable body engaging portion, and transportationof fluid from the second hydraulically operable body engaging portion tothe second reservoir.

According to one embodiment of the operable hydraulic implant, a wall ofthe enclosure constitutes at least a portion of the wall of thereservoir, and at least one movable wall portion could be positionedbetween the reservoir and the gear system, such that the portion of theat least one movable wall portion separates the reservoir from a portionof the enclosure enclosing the gear system, such that the gear system issealed from the reservoir.

The operable hydraulic implant further comprises a second gear systemenclosed by the enclosure, and the second gear system is adapted toreceive mechanical work of the different second force and velocity fromthe output of the first gear system, and output mechanical work having adifferent third force and velocity.

The second gear system comprises: an operable element, a first gearhaving the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof, wherein the operableelement is adapted to engage the inside of the first gear, such that theoutside of the first gear is pressed against the inside of the secondgear such that the teeth of the first gear are interengaged with theteeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear, andwherein the first gear of the first gear system is directly orindirectly connected to the operable element of the second gear system,such that the first and second gear systems functions as a single gearsystem.

According to one embodiment, the operable element of at least one of thefirst and second gear systems could comprise at least one of; a planetgear and a wheel or structure using a frictional connection.

The operable hydraulic implant could, further comprise at least onebattery enclosed by the enclosure, and adapted to energize theelectrical motor.

According to one embodiment, the operable hydraulic implant furthercomprises a receiving unit adapted to receive wireless energytransmitted from outside the patient's body.

The receiving unit is adapted to be enclosed by the enclosure, such thatthe receiving unit is sealed from the bodily fluids.

The operable hydraulic implant may further comprise a distance elementadapted to create a distance between the receiving unit and at least oneof; the gear system and the electrical motor, such that the receivingunit is removed from metallic and/or magnetic components of the gearsystem and/or electrical motor.

The receiving unit could be adapted to charge the battery according toany one of the embodiments herein.

In one embodiment, the operable hydraulic implant further comprises amagnetic coupling comprising a first part connected to the operableelement of the gear system and enclosed by the enclosure, and a secondpart being: positioned on the outside of the enclosure, connected to anelectrical motor positioned such that operation of the electrical motoroperates the second part of the magnetic coupling, and magneticallyconnected to the first part of the magnetic coupling, such that thefirst part of the magnetic coupling rotates along with the second partof the magnetic coupling, such that the electrical motor propels thegear system through the wall of the enclosure.

The operable hydraulic implant could according to one embodiment furthercomprise an implanted electrical motor, and the second part could beconnected to the implantable electrical motor. The second part of themagnetic coupling could be connected to an external drive unit adaptedto propel the first unit from the outside of the patient's body.

The electrical motor could be an electrical motor selected from: analternating current (AC) electrical motor, a direct current electricalmotor, a linear electrical motor, an axial electrical motor, a radialmotor, a three-phase motor, a more than one-phase motor, apiezo-electric motor, a bimetal motor, and a memory metal motor.

The enclosure of the implantable hydraulic unit could comprise amaterial selected from: a carbon material, a boron material, a mixtureof material, a Peek® material, an alloy of material, a metallicmaterial, titanium, aluminum, a ceramic material, a polymer material,polyurethane, polyether ether ketone, silicone, and Parylene® coatedsilicone.

An operable implant for implantation in the body of a patient isprovided. The operable implant comprises at least one fixation memberadapted to directly or indirectly fixate the operable implant towards atleast one of; at least one muscular fascia, at least one bone fascia, atleast one cortical bone layer, at least one muscular layer, fibrotictissue, any part of the abdominal wall, and any part of the subcutaneousspace and its surroundings in the body, and at least one adjustabledistance element adapted to; in one end thereof, be directly orindirectly connected to at least a part of the operable implant, in theother end thereof, be directly or indirectly connected to the fixationmember, and adjust the distance between the part of the operable implantconnected to the adjustable distance element, and the fixation member.

The operable implant could comprise at least one part selected from alist consisting of: an operation device, a control unit a receivingunit, for receiving wireless energy, a coil, for receiving wirelessenergy, a receiving unit, for receiving a magnetic field or anelectromagnetic field, a magnetic force transferring coupling, anelectrical circuit, a push button for controlling any function of theoperable implant, an energy storage device, a pushable construction foradjusting the adjustable distance element, an integrated operationdevice and receiving unit, for receiving wireless energy or a magneticfield or an electromagnetic field adapted to generate kinetic energy, acasing for enclosing at least one of the different parts of the operableimplant two or more casings for enclosing at least one of the differentparts of the operable implant in each casing. The at least oneadjustable distance element could be adapted to adjust the distancebetween: the fixation member, and at least one of the parts above.

According to one embodiment of the operable implant, the at least onefixation member is integrated with at least one of: an operation device,a control unit, a receiving unit, for receiving wireless energy, a coil,for receiving wireless energy, a receiving unit, for receiving amagnetic field or an electromagnetic field, a magnetic forcetransferring coupling, an electrical circuit, a push button forcontrolling any function of the operable implant, an energy storagedevice, a pushable construction for adjusting the adjustable distanceelement, an integrated operation device and receiving unit, forreceiving wireless energy or a magnetic field or an electromagneticfield adapted to generate kinetic energy, a casing for enclosing atleast one of the different parts of the operable implant, two or morecasings for enclosing at least one of the different parts of theoperable implant in each casing, and an integrated unit comprising twoor more of the parts. The at least one adjustable distance element isadapted to adjust the distance between; the fixation member integratedwith one or more of the parts of the operable implant.

According to one embodiment, the at least one adjustable distanceelement is adjustable from outside the body of the patient.

According to one embodiment, the at least one adjustable distanceelement is adjustable electrically or manually from outside the body ofthe patient. The at least one adjustable distance element could comprisetwo, three, four or more adjustable distance elements.

According to one embodiment, the at least one adjustable distanceelement comprises a threaded member for transferring a rotating movementto a linear movement for adjusting the distance.

The at least one adjustable distance element or operable implant couldcomprise an x-ray detectable element, such that the distance adjusted bythe at least one adjustable distance element can be measured on an x-rayimage, and/or an element detectable by means of ultrasound, such thatthe distance adjusted by the at least one adjustable distance elementcan be measured by means of ultrasound.

At least one part of the operable implant may be adapted to be placedsubcutaneously and/or the operation device may be adapted to be placedsubcutaneously.

The operation device of the operable implant may be adapted to befixated to at least one of, at least one fascia layer and at least onemuscular layer of the abdominal wall.

The at least one adjustable distance element may be adapted to be placedthrough at least one of, at least one fascia layer and at least onemuscular layer of the abdominal wall.

The adjustable distance element in any of the embodiments herein may beflexible such that the different parts of the operable implant can flexin relation to each other.

In one embodiment, the receiving unit comprises at least one coiladapted to transform wireless energy, received in form of an electric,magnetic or electromagnetic field, into electrical energy.Alternatively, the receiving unit comprises at least a first coil havinga first number of windings, and at least a second coil having a second,different number of windings.

The operable implant may further comprise at least one enclosure adaptedto hermetically enclose at least one part of the operable implant and/orthe adjustable distance element.

The at least one adjustable distance element in any of the embodimentsmay comprise a lead for transferring electrical current from thereceiving unit to the operation device.

The operable implant may further comprise a control unit for controllingat least one parameter of the operable implant. The control unit may beadapted to wirelessly communicate with an external unit, such that thecontrol unit can be wirelessly controlled from outside the body.

According to one embodiment, at least one of; the receiving unit and theat least one adjustable distance element may be free from magneticcomponents.

The at least one enclosure in any of the embodiments may comprise two ormore enclosures, and the at least one adjustable distance element may beadapted to adjust the distance between the enclosures.

A surgical kit for an operable implant enabling adjustment of a distancebetween at least one fixation member of the operable implant and atleast one part of the operable implant is further provided. The surgicalkit comprises at least one first distance element having: a firstconnecting portion adapted to directly or indirectly connect to the atleast one part of the operable implant, and a second connecting portionadapted to directly or indirectly connect to the at least one fixationmember of the operable implant, for creating a first distance betweenthe at least one part of the operable implant and the at least onefixation member of the operable implant, and at least one seconddistance element having: a first connecting portion adapted to directlyor indirectly connect to at least one part of the operable implant, anda second connecting portion adapted to directly or indirectly connect tothe at least one fixation member of the operable implant for creating asecond longer distance between the at least one part of the operableimplant and the at least one fixation member of the operable implant.

According to one embodiment of the surgical kit, at least one of the atleast one first and second distance elements comprises an x-raydetectable element, such that the distance between the at least one partof the operable implant and the at least one fixation member of theoperable implant can be measured on an x-ray image.

In one embodiment of the surgical kit, at least one of; the at least onefirst and second distance elements comprises an element detectable bymeans of ultrasound, such that the distance between the at least onepart of the operable implant and the at least one fixation member of theoperable implant can be measured by means of ultrasound.

According to one embodiment, at least one of the at least one first andsecond distance elements may be adapted to be placed subcutaneously.

At least one of; the at least one the first and second distance elementsmay be adapted to be fixated to at least one of; at least one muscularfascia, at least one bone fascia, at least one cortical bone layer, atleast one muscular layer, fibrotic tissue, any part of the abdominalwall, and any part of the subcutaneous space and its surroundings in thebody.

At least one of the first and second distance elements in any of theembodiments of the surgical kit may be adapted to create a distancebetween the muscular layer of the abdominal wall and an operation deviceof the operable implant.

At least one of the first and second distance elements of the surgicalkit may be adapted to be placed through at least one of, at least onefascia layer and at least one muscular layer of the abdominal wall.

At least one of the first and second distance elements may be flexiblesuch that the different parts of the operable implant can move inrelation to each other.

In any of the embodiments herein, at least one of the first and seconddistance elements may be free from magnetic components.

At least one of the first and second distance elements may be adapted toguide a lead for transferring electrical current from a wireless energyreceiving unit to an operation device of the operable implant.

At least one of the first and second distance element may be adapted tofixate a wireless energy receiving unit in the body of the patient in anoptimal position and hinder the body from rejecting the wireless energyreceiving unit.

A system for adjusting a distance in an operable implant is furtherprovided. The system comprises the surgical kit according to any one ofthe embodiments herein and an operable implant comprising at least onefixation member and at least one part selected from a list consistingof: an operation device, a control unit, a receiving unit, for receivingwireless energy, a coil, for receiving wireless energy, a receivingunit, for receiving a magnetic field or an electromagnetic field, amagnetic force transferring coupling, an electrical circuit, a pushbutton for controlling any function of the operable implant, an energystorage device, a pushable construction for adjusting the adjustabledistance element, an integrated operation device and receiving unit, forreceiving wireless energy or a magnetic field or an electromagneticfield adapted to generate kinetic energy, a casing for enclosing atleast one of the different parts of the operable implant, and two ormore casings for enclosing at least one of the different parts of theoperable implant in each casing. At least one of the first and seconddistance elements may be adapted to create a distance between thefixation member and at least one of the parts above.

The at least one fixation member may be integrated with at least one of:an operation device, a control unit a receiving unit, for receivingwireless energy, a coil, for receiving wireless energy, a receivingunit, for receiving a magnetic field or an electromagnetic field, amagnetic force transferring coupling, an electric circuit, a push buttonfor controlling any function of the operable implant, an energy storagedevice, a pushable construction for adjusting the adjustable distanceelement, an integrated operation device and receiving unit, forreceiving wireless energy or a magnetic field or an electromagneticfield adapted to generate kinetic energy, a casing for enclosing atleast one of the different parts of the operable implant, and two ormore casings for enclosing at least one of the different parts of theoperable implant in each casing. At least one of; the first and seconddistance element may be adapted to create a distance between; thefixation member integrated with one or more of parts above, and one ormore other parts of any of the embodiments.

According to one embodiment, at least one of the first and seconddistance elements comprises a lead for transferring electrical currentfrom the wireless energy receiving unit to the operation device.

At least one part of the operable implant may be adapted to be placedsubcutaneously, or the operation device may be adapted to be placedsubcutaneously.

According to one embodiment, the operation device is adapted to befixated to at least one of, at least one fascia layer and at least onemuscular layer of the abdominal wall.

The receiving unit could further comprise at least one coil adapted totransform wireless energy, received in form of an electric, magnetic orelectromagnetic field, into electrical energy. The receiving unit maycomprise at least a first coil having a first number of windings, and atleast a second coil having a second, different number of windings.

The system may further comprise at least one enclosure adapted tohermetically enclose at least any one part according to any of theembodiments, and the adjustable distance element.

According to one embodiment, the system further comprises at least oneenclosure adapted to hermetically enclose at least one of the parts ofany of the embodiments herein.

The control unit of the system may be adapted to control at least oneparameter of the operable implant, and the control unit may be adaptedto wirelessly communicate with an external unit, such that the controlunit can be wirelessly controlled from outside the body.

According to one embodiment, the at least one enclosure comprises two ormore enclosures, and one of the first and second distance element may beadapted to adjust the distance between the two enclosures.

An operable implant for implantation in a patient is provided. Theoperable implant comprises a body engaging portion and an operationdevice for supplying force to the body engaging portion. The operationdevice comprises an implantable gear system adapted to, at a forceinput; receive mechanical work of a first force and velocity, and, at aforce output; supply mechanical work having a different second force andsecond velocity to operate the body engaging portion. The gear systemcomprises an operable element connected to the force input, a first gearconnected to the force output, first gear having the shape of a hollowcylinder, comprising a first number of teeth, on the peripheral outsidethereof, and a second gear having the shape of a hollow cylinder,comprising a greater number of teeth than the first gear, on the insidesurface thereof. The operable element may be adapted to engage theinside of the first gear, such that the outside of the first gear ispressed against the inside of the second gear such that the teeth of thefirst gear are interengaged with the teeth of the second gear in atleast one position interspaced by positions at which the teeth are notinterengaged, and wherein the operation of the operable element advancesthe positions and thereby causes relative rotation between the firstgear and the second gear.

According to one embodiment, the operable element is adapted to deflectthe first gear, and to maintain the first gear deflected such that theteeth of the first gear are interengaged with the teeth of the secondgear in one or more angularly spaced positions interspaced by positionsat which the teeth are not interengaged.

The operable element may be adapted to deflect the first gear, and tomaintain the first gear deflected such that the teeth of the first gearare interengaged with the teeth of the second gear in at least two ormore angularly spaced positions interspaced by positions at which theteeth are not interengaged.

According to one embodiment, the operation device comprises animplantable electrical motor for transforming electrical energy tomechanical work. The electrical motor may be connected to the forceinput.

The electrical motor may be an electrical motor selected from: analternating current (AC) electrical motor, a direct current electricalmotor, a linear electrical motor, an axial electrical motor, apiezo-electric motor, a three-phase motor, a more than one-phase motor,bimetal motor, and a memory metal motor.

The operable implant according to any one of the embodiments herein mayfurther comprise a magnetic coupling connected to the force input, suchthat mechanical work of the first force and velocity is supplied to thegear system by means of the magnetic coupling. The magnetic couplingcould be connected to the force output, such that mechanical work of thesecond force and velocity is supplied to the body engaging portion bymeans of the magnetic coupling.

According to one embodiment, the magnetic coupling is adapted totransfer at least one of; rotating force and reciprocating force.

The magnetic coupling may comprise a rotating element placed inside asealed enclosure enclosing at least the gear system of the operableimplant, the rotating element comprising at least one magnet or aportion comprising magnetic or magnetizable material. The magnet orportion comprising magnetic or magnetizable material may be adapted torotate to transfer force to a corresponding rotating element on theoutside of the sealed enclosure, for directly or indirectly supplyingforce to the body engaging portion through the sealed enclosure.

The magnetic force coupling may comprise a rotating element placedinside a sealed enclosure comprising at least one magnet or a portioncomprising magnetic or magnetizable material, adapted to be rotated whenreceiving transfer force from a corresponding external rotating elementplaced on the outside of the hermetic enclosure and on the outside ofthe body, for directly supplying force to the rotating element placedinside the sealed enclosure.

The operable implant may further comprise an enclosure adapted tohermetically enclose the operable implant.

The gear system in any of the embodiments may further comprise a thirdgear having the shape of a hollow cylinder. The inside of the third gearmay comprise the same amount of teeth as the outside of the first gear,the teeth of the third gear may be adapted to interengage the teeth ofthe first gear such that the third gear rotates in relation to thesecond gear, along with the at least one interengaged position.

According to one embodiment, the third gear is connected to a secondgear system, such that the first and second gear systems functions as asingle gear system. The second gear system comprises a force inputadapted to receive mechanical work of the second force and secondvelocity from the force output of the first gear system, and a forceoutput adapted to supply mechanical work to the body engaging portionhaving a different third force and third velocity. The second gearsystem may comprise an operable element connected to the force input ofthe second gear system, a first gear connected to the force output ofthe second gear system, having the shape of a hollow cylinder,comprising a first number of teeth, on the peripheral outside thereof,and a second gear having the shape of a hollow cylinder, comprising agreater number of teeth than the first gear, on the inside surfacethereof. The operable element may be adapted to engage the inside of thefirst gear, such that the outside of the first gear is pressed againstthe inside of the second gear such that the teeth of the first gear areinterengaged with the teeth of the second gear in at least one positioninterspaced by positions at which the teeth are not interengaged, andwherein the operation of the operable element advances the at least oneposition and thereby causes relative rotation between the first gear andthe second gear.

According to one embodiment, the operable element of at least one of thefirst and second gear systems comprises at least one of; a planetarygear and a structure or wheel at least partly using friction to enablerotating force to be transported.

In any of the embodiments herein, the force output of the first orsecond gear system may be directly or indirectly connected to a threadedmember adapted to transform rotating force to linear force.

According to another embodiment, the operable implant further comprisesa reservoir comprising a movable wall portion adapted to change thevolume of the reservoir. The threaded member may be directly orindirectly connected to the movable wall portion, such that operation ofthe threaded member changes the volume of the reservoir.

The operable implant may in some embodiments additionally comprise asecond reservoir comprising a movable wall portion, and the threadedmember may be directly or indirectly connected to the movable wallportion of the second reservoir for changing the volume of the secondreservoir. The movement of the movable wall portion of the firstreservoir, by the threaded member in a first direction, may cause thefirst reservoir to expand and the volume of the first fluid reservoir toincrease, and the movement of the movable wall portion of the secondreservoir by the threaded member in a first direction may cause thesecond reservoir to contract and the volume of the second reservoir todecrease.

The first reservoir may be in fluid connection with a first bodyengaging portion, and the second reservoir may be in fluid connectionwith a second body engaging portion, and operation of the operationdevice in a first direction, by the connection with the threaded member,may cause: transportation of fluid from the first reservoir to the firstbody engaging portion, and transportation of fluid from the second bodyengaging portion to the second reservoir.

The reservoir in any of the embodiments may be at least one of circularand torus shaped.

The operable implant in any of the embodiments may further comprise aperistaltic pump comprising a hollow member for fluid transportation,and an operable compression member adapted to engage and compress thehollow member. The force output may be in direct or indirect connectionwith the compression member, such that the operation of the operationdevice operates the compression member such that fluid is transported inthe hollow member.

The operable implant may further comprise a friction coupling adapted tolimit the torque that can be supplied by the operation device. Thefriction coupling may be positioned between the operation device and thebody engaging portion, such that the torque required to start theoperation device is reduced.

The operable implant may further comprise a reservoir for holding ahydraulic fluid. The reservoir comprising a movable wall portion adaptedto change the volume of the reservoir. The movable wall portion may bedirectly or indirectly connected to the gear system force outlet, suchthat operation of the gear system changes the volume of the reservoir.

The electrical motor in any one of the preceding embodiments may be aone, two, three or more phase motor, comprising at least one of; anaxial electrical motor, a radial electrical motor, and a linearelectrical motor.

The operable implant may further comprise a separate receiving unitadapted to receive wireless energy; the receiving unit may comprise atleast one coil adapted to transform wireless energy received in form ofa magnetic, electric or electromagnetic field into electrical energy.

The operable implant may further comprise at least one distance elementadapted to create a distance between the receiving unit and at least oneof the skin of the patient and any metallic, magnetic or magnetizablepart of the operable implant, such that the receiving unit remainssubstantially unaffected by metallic and/or magnetic parts of theoperable implant.

The at least one distance element may be adjustable.

The operable implant may further comprise at least one fixation memberfor fixating at least a part of the operable implant to at least one ofmuscular fascia, bone fascia, cortical bone, muscular layer, fibrotictissue, and a at least one layer towards the inside of the subcutaneousspace of the patient.

A medical system for transferring energy from the outside of the body ofa patient to an operable implant placed inside the body of the patientis further provided. The medical system comprises: an external driveunit, and an operable implant. The external drive unit comprises anexternal rotating structure comprising at least one magnet for creatinga rotating magnetic field adapted to magnetically connect to at leastone of: a magnet, magnetizable material or magnetic material of theoperable implant for transferring force from the external drive unit tothe magnet or magnetic material of the implant in the body of thepatient, and at least one coil of the operable implant for inducingelectrical current in the body of the patient. The provided medicalsystem can transfer rotating kinetic force for directly or indirectlypowering a medical implant.

The magnet or magnetic material of the operable implant is may befixated to an internal rotating structure adapted to rotate along withthe rotating magnetic field of the external drive unit for operating theoperable implant.

According to one embodiment, the magnet or magnetic material of theoperable implant may be fixated to an internal reciprocating structureadapted to reciprocate with the rotating magnetic field of the externaldrive unit for operating the operable implant.

The internal reciprocating structure may be adapted to reciprocate dueto the magnetic connection with a magnetic field which shiftingpolarity, such that the magnets of the internal reciprocating structureis alternatingly attracted and repelled by the rotating magnetic fieldcreated by the external drive unit.

The external rotating structure may have a larger diameter than theinternal rotating structure, and the magnets may be arranged such thatthe radial force, enabling the magnets of the internal rotatingstructure to rotate along with the magnets of the external rotatingstructure, is greater than the axial force, exerted by the magnets,pressing the internal structure against the external structure, thusreducing the risk that the magnetic force will injure the patient'sskin.

According to one embodiment, at least one of the internal rotatingstructure and the external rotating structure may comprise a repellingmagnet adapted to decrease the axial forces created by the magneticconnection between the internal and external magnets and/or magneticmaterial, such that the squeezing effect on the patient's skin isreduced.

The force of the repelling or attracting magnet may be adjustable, suchthat the squeezing effect on the patient's skin can be adjusted.

The repelling magnet of any of the embodiments may be an repellingelectromagnet, and the force of the repelling electromagnet may beadjusted by altering the current to the electromagnet.

According to one embodiment, the repelling magnet is a permanent magnetand the force of the repelling permanent magnet may be adjustable byaltering the distance between or position of the permanent magnet inrelation to the patient's skin.

The internal rotating structure may comprise an internal spherical cap,and the magnets or magnetic material of the internal rotating structuremay be positioned on the outside of said internal spherical cap. Theexternal rotating structure may comprise an external spherical cap, andthe magnets or magnetic material of the external rotating structure maybe positioned on inside of said external spherical cap, such thatrotating force can be transferred radially by means of the magneticconnection between the internal and external spherical caps.

According to one embodiment, the internal spherical cap comprises acentrally placed magnet, and the external spherical cap comprises acentrally placed magnet, and wherein the magnets of the internal andexternal spherical caps are adapted to exert repelling forces on eachother such that the axial forces created by the magnetic connectionbetween the internal and external magnets and/or magnetic material isreduced, such that the squeezing effect on the patient's skin isreduced.

The medical system may further comprise a gear system connected to theinternal rotating structure. The gear system may be adapted to receivemechanical work of a first force and velocity and supply mechanical workhaving a different force and velocity.

The gear system may comprise: an operable element, a first gearcomprising a first number of teeth, on the outside thereof, and a secondgear comprising a greater number of teeth than the first gear, on theinside thereof. The operable element may be adapted to press the outsideof the first gear towards the inside of the second gear such that theteeth of the first gear are interengaged with the teeth of the secondgear in at least one position interspaced by positions at which theteeth are not interengaged, and wherein the operation of the operableelement advances the positions and thereby causes relative rotationbetween the first gear and the second gear.

According to one embodiment, the operable implant comprises an operationdevice and a body engaging portion. The operation device may comprise ahydraulic operation device. The body engaging portion may be ahydraulically operable body engaging portion, and the operable implantmay further comprise a hydraulic pump and a reservoir adapted to holdhydraulic fluid, the reservoir being connected to the hydraulic pump.The hydraulic pump may be adapted to transport hydraulic fluid from thereservoir to the body engaging portion.

The hydraulic pump may comprise a movable wall portion of the reservoir,and the hydraulic pump may be adapted to transport hydraulic fluid fromthe reservoir to the hydraulically operable body engaging portion bymoving the movable wall portion and thereby changing the volume of thereservoir.

According to one embodiment, the operation device comprises anelectrical motor comprising a static part comprising a plurality ofcoils and a movable part comprising a plurality of magnets, such thatsequential energizing of said coils magnetically propels the magnets andthus propels the movable part. The operation device may further comprisean enclosure adapted to hermetically enclose the coils of the staticpart, such that a seal is created between the static part and thepropelled moving part with the included magnets, such that the coils ofthe static part are sealed from the bodily fluids, when implanted.

The medical system may further comprise an implantable electricalgenerator comprising: a movable generator portion comprising at leastone generator magnet connected to the magnet or magnetic material of theoperable implant, such that the movement of the magnet or magneticmaterial moves the movable generator portion, and at least one coil inmagnetic connection with the at least one generator magnet, such thatelectrical current is induced in the coil by the movement of the movablegenerator portion in relation to the coil.

According to one embodiment, the movable generator portion is adapted toperform rotating movements.

The implantable electrical generator may be an implantable rotationalelectrical generator, and the movable generator portion may be adaptedto perform rotating movement, and at least one coil may be in magneticconnection with the at least one magnet, such that rotating movement ofthe movable generator portion induces current in the at least one coil.

The movable generator portion may be adapted to perform reciprocatingmovements.

The implantable electrical generator may be an implantable linearelectrical generator, and the movable generator portion may be adaptedto perform reciprocating movement, and the at least one coil may be inmagnetic connection with the at least one magnet, such thatreciprocating movement of the movable generator portion induces currentin the at least one coil.

According to one embodiment, the operable implant comprises a pluralityof coils arranged in a circular configuration, such that the rotatingmagnetic field by the external drive unit sequentially induceselectrical current in the plurality of coils.

The medical system may further comprise at least one battery or energystorage device connected to the at least one coil, such that the currentinduced in the at least one coil can be stored as electrical energy inthe battery.

The medical system may further comprise an enclosure adapted tohermetically enclose the operable implant, such that the operableimplant is sealed from the bodily fluids of the patient.

The operable implant in any of embodiments may be adapted to beimplanted subcutaneously.

According to one embodiment, the operable implant comprises an operationdevice and a body engaging portion. The operation device comprises amovable part directly or indirectly connected to the body engagingportion, the movable part being connected to at least one magnet,magnetizable material or magnetic material. The movable part may beadapted to magnetically connect to a moving magnetic field on theoutside of the patient's body, such that the movable part moves alongwith the movable magnetic field. The operation device further comprisesan implantable generator connected to the movable part and adapted totransform movement to electrical current, such that the movement of themovable part operates the body engaging portion and generates electricalcurrent.

At least one magnet, magnetizable material or magnetic material may beconnected to a rotating structure and adapted to magnetically connect toa rotating magnetic field on the outside of the skin of the patient,such that the rotating structure rotates along with the rotatingmagnetic field.

At least one magnet, magnetizable material or magnetic material may beconnected to a structure adapted for reciprocating movement and adaptedto magnetically connect to a reciprocating magnetic field on the outsideof the skin of the patient, such that the structure for reciprocatingmovement moves along with the reciprocating magnetic field.

The implantable generator may further comprise at least one magnet andat least one coil, and the movement of the at least one magnet inrelation to the at least one coil may induce an electrical current inthe at least one coil. At least one magnet of the movable part may beadapted to magnetically connect to a moving magnetic field on theoutside of the patient's body, also functions as the at least one magnetin the implantable generator.

According to one embodiment, the operable implant further comprises abattery or energy storage adapted to be charged by the implantablegenerator. The battery or energy storage may be adapted to power thebody engaging portion.

The operable implant may further comprise a control unit for controllingat least one parameter of the operable implant.

The control unit may be connected to the battery or energy storage suchthat the battery powers the control unit.

The operation device may comprise a hydraulic operation device.

According to one embodiment, the body engaging portion may be ahydraulically operable body engaging portion, and the operable implantmay further comprise a hydraulic pump and a reservoir adapted to holdhydraulic fluid, the reservoir being connected to the hydraulic pump.The hydraulic pump may be adapted to transport hydraulic fluid from thereservoir to the body engaging portion.

The hydraulic pump may comprise a movable wall portion of the reservoir,and the hydraulic pump may be adapted to transport hydraulic fluid fromthe reservoir to the hydraulically operable body engaging portion bymoving the movable wall portion and thereby changing the volume of thereservoir.

According to one embodiment, the hydraulic pump may be a hydraulic pumpselected from: peristaltic pumps, membrane pumps, gear pumps, andbellows pumps.

The operation device in any of the embodiments herein, may comprise agear system adapted to receive mechanical work of a first force andvelocity as input, and output mechanical work having a different forceand velocity.

The gear system of the operation device may comprise: an operableelement, a first gear having the shape of a hollow cylinder, comprisinga first number of teeth, on the peripheral outside thereof, and a secondgear having the shape of a hollow cylinder, comprising a greater numberof teeth than the first gear, on the inside surface thereof. Theoperable element may be adapted to engage the inside of the first gear,such that the outside of the first gear is pressed against the inside ofthe second gear such that the teeth of the first gear are interengagedwith the teeth of the second gear in at least one position interspacedby positions at which the teeth are not interengaged. The operation ofthe operable element advances the positions and thereby causes relativerotation between the first gear and the second gear.

According to one embodiment, the operable element is connected to themovable part, such that the movement of the movable part operates thegear system.

According to one embodiment, the operable implant further comprises anenclosure adapted to enclose the operable implant.

In any of the embodiments herein, the movable part of the gear systemmay be placed subcutaneously.

The operation device may be adapted to be fixated to at least onefascia, fibrotic tissue, skin, muscular layer or any tissuesubcutaneosly in the abdominal wall or in the abdomen.

The operation device may further comprise a distance element adapted tocreate a distance between the operation device and the movable part.

The distance element may be adapted to control the position of themovable part hindering the body from rejecting the movable part.

According to one embodiment, of the operable implant, the operableimplant further comprises a wireless communication unit adapted towirelessly communicate with an external unit.

According to one embodiment, the system further comprises an externalunit comprising an external drive unit for supplying a driving force tothe operable implant.

The external drive unit may comprise moving magnets adapted to createthe moving magnetic field, or may comprise coils, and wherein sequentialenergizing of the coils creates the moving magnetic field.

According to one embodiment, the external drive unit further comprises awireless communication unit adapted to wirelessly communicate with theoperable implant.

An operable hydraulic implant is further provided. The operablehydraulic implant comprises a body engaging portion, a powered operationdevice, in fluid connection with the body engaging portion. Theoperation device comprises: a reservoir for holding a hydraulic fluid,wherein the reservoir comprises a movable wall portion adapted to moveto alter the volume of the reservoir and thereby transport hydraulicfluid from the reservoir to the body engaging portion, and an operationmember connected to the movable wall portion, such that operation of theoperation member alters the volume of the reservoir, and a flexibleenclosure adapted to; have its volume altered by changing the outer sizeand shape of the enclosure and enclose the movable wall portion and theoperation member. The movable wall portion may be adapted to move insideof the enclosure, such that the volume of the reservoir can be changedby affecting the outer dimensions of the operable hydraulic implant bythe movement of the movable wall portion inside of the enclosure.

The reservoir further comprises a manual portion adapted to becompressed by manual force from outside of the body of the patient, suchthat fluid can be transported from the reservoir to the body engagingportion of the operable hydraulic implant, by means of manual force, fortemporarily increasing the hydraulic pressure at the body engagingportion. The manual portion may enable manual override and/or theaddition of pressure to the reservoir and/or emergency operation.

The reservoir in any of the embodiments herein may be substantiallycircular or elliptic.

According to one embodiment, the average thickness of the movable wallportion is less than the average thickness of the manual portion of thereservoir.

According to one embodiment of the operable hydraulic implant, thereservoir comprises Parylene® coated silicone.

In one embodiment, the operation device is connected to a threadedmember adapted to transform a radially rotating force to an axiallyreciprocating force, and the threaded member may be connected to theoperation member.

The operable hydraulic implant may further comprise an electricalcircuit and a control unit for controlling the operable hydraulicimplant.

The operable hydraulic implant may further comprise an injection portfor injecting hydraulic fluid into the reservoir from outside the bodyof the patient.

At least a portion of the operable hydraulic implant may be adapted tobe implanted subcutaneously.

The operable hydraulic implant may further comprise at least onefixation member adapted to directly or indirectly fixate at least aportion of the operable hydraulic implant towards at least one of; atleast one muscular fascia, at least one bone fascia, at least onecortical bone layer, at least one muscular layer, fibrotic tissue, anypart of the abdominal wall, and any part of the subcutaneous space andits surroundings in the body.

The operable hydraulic may further comprise a second body engagingportion and a second reservoir in fluid connection with the second bodyengaging portion. The second reservoir may comprise a movable wallportion adapted to move to alter the volume of the second reservoir andthereby transport hydraulic fluid from the second reservoir to thesecond body engaging portion.

The movable walls of the first and second reservoirs may be connected tothe same operation member, adapted to increase or decrease the size ofthe reservoirs, and the volume of the first reservoir may be adapted tobe changed in the opposite direction from the second reservoir.

According to one embodiment, the operation device comprises anelectrical motor connected to the operation member. The electrical motormay be an electrical motor selected from: an alternating current (AC)electrical motor, a direct current electrical motor, a linear electricalmotor, an axial electrical motor, a piezo-electric motor, a two or morephase motor, a three phase motor, a bimetal motor, and a memory metalmotor.

According to one embodiment, operation of the electrical motor affectsboth the movable walls of both the first and second reservoirs.

The operation device may comprise a gear system adapted to receivemechanical work of a first force and velocity and supply mechanical workhaving a different second force and second velocity. The gear system maycomprise a force input connected to an electrical motor, and a forceoutput connected directly or indirectly to the operation member.

The gear system may comprise: an operable element, a first gear havingthe shape of a hollow cylinder, comprising a first number of teeth, onthe peripheral outside thereof, and a second gear having the shape of ahollow cylinder, comprising a greater number of teeth than the firstgear, on the inside surface thereof, wherein the operable element isadapted to engage the inside of the first gear, such that the outside ofthe first gear is pressed against the inside of the second gear suchthat the teeth of the first gear are interengaged with the teeth of thesecond gear in at least one position interspaced by positions at whichthe teeth are not interengaged, and wherein the operation of theoperable element advances the positions and thereby causes relativerotation between the first gear and the second gear.

The gear system may be connected to a threaded member adapted totransform a radially rotating force to an axially reciprocating force,and wherein the threaded member is connected to the operation member.

According to one embodiment, the operation device comprises a magneticcoupling adapted to be in magnetic connection with an external portionof a magnetic coupling, adapted to be positioned on the outside of thepatient's body, such that the internal portion of the magnetic couplingmoves along with the external portion of the magnetic coupling, foroperating the movable wall portion.

The operable hydraulic implant may further comprise a wirelesscommunication unit for wirelessly communicating with an external unitpositioned on the outside of the patient's body.

The operable hydraulic implant may further comprise at least one batteryadapted to store electrical energy in the body of the patient.

A medical system comprising an operable implant adapted to be placedinside the body of the patient is further provided. The operable implantcomprises a movable structure adapted for reciprocating movement, themovable structure comprising at least one magnet or magnetic material,and the movable structure may be adapted to be in magnetic connectionwith an external unit creating a reciprocating magnetic orelectromagnetic field, such that the movable structure reciprocatesalong with the reciprocating magnetic or electromagnetic field.

According to one embodiment, the operable implant further comprises anelectrical generator connected to the movable structure and beingadapted to transform the reciprocating movements of the movablestructure to electrical energy.

The electrical generator may comprise: a movable generator portioncomprising at least one magnet, wherein the movable generator portion isconnected to the movable structure and at least one coil in magneticconnection with the at least one magnet. The electrical current isinduced in the coil by the movement of the movable generator portion inrelation to the coil.

According to one embodiment, the at least one magnet of the movablegenerator portion is the magnet of the movable structure.

The operable implant may further comprise a force transforming memberadapted to transform reciprocating force to rotating force. Theelectrical generator may be a rotating electrical generator connected tothe force transforming member.

The electrical generator may be a linear electrical generatorcomprising: a reciprocating generator portion comprising at least onemagnet, wherein the reciprocating generator portion is in connectionwith the movable structure adapted to perform reciprocating movement,and at least one coil in magnetic connection with the at least onemagnet, such that reciprocating movement of the reciprocating generatorportion induces current in the at least one coil.

According to one embodiment, the movable structure is spring loaded inone direction, such that the reciprocating movement is created bymagnetic force from the magnetic connection with the external unit inone direction, and by the movable portion being spring loaded in theopposite direction.

The operable implant may further comprise a battery or energy storingdevice connected to the electrical generator unit, the battery may beadapted to store electrical energy generated in the generator unit.

According to one embodiment, the operable implant may further comprisebody engaging portion in connection with the movable structure, suchthat movement of the movable structure operates the body engagingportion.

The medical system in any of the embodiments may further comprise anenclosure adapted to hermetically enclose the operable implant, suchthat the implantable electrical generator is sealed from the bodilyfluids of the patient.

The medical system according to any one of the preceding embodiments mayfurther comprise a wireless communication unit adapted to at least oneof: receive wireless communication signals from the external unit, andtransmit wireless communication signals to the external unit.

The operable implant in any of the embodiments herein may be adapted tobe implanted subcutaneously, which may be subcutaneously in the abdomen.

According to one embodiment, the operable implant further comprises anexternal unit comprising an external drive unit adapted to create areciprocating magnetic field on the outside of the patient's skinadapted to affect at least one magnet or magnetic material of anoperable implant such that the magnet or magnetic material reciprocatesalong with the reciprocating magnetic field of the external unit.

The external drive unit may further comprise a reciprocating structurecomprising at least one magnet, electromagnet or magnetic material, andthe reciprocation of the reciprocating structure may affects a magnet ormagnetic material of a movable structure of an implantable electricalgenerator causing reciprocation thereof.

According to one embodiment, the external drive unit may comprise arotatable structure comprising at least one magnet, electromagnet ormagnetic material. Rotation of the rotatable structure affects a magnetor magnetic material of a movable structure of an implantable electricalgenerator causing reciprocation thereof.

The rotatable structure of the external drive unit may comprise: a firstmagnet or electromagnet creating a positive magnetic field, and a secondmagnet or electromagnet creating a negative magnetic field, such thatrotation of the rotatable structure causes the first and second magnetor electromagnet to alternatingly affect the magnet or magnetic materialof the operable implant, causing reciprocation thereof.

According to one embodiment, the external drive unit comprises anelectromagnet for alternatingly creating a magnetic field with positiveand negative polarity, which causes reciprocation of a magnet ormagnetic material of an implantable electrical generator.

According to one embodiment, the operable implant further comprises agear system adapted to receive mechanical work of a first force andvelocity as input, and output mechanical work having a different forceand velocity, the gear system comprises: an operable element, a firstgear having the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on the inside surface thereof, wherein the operableelement is adapted to engage the inside of the first gear, such that theoutside of the first gear is pressed against the inside of the secondgear such that the teeth of the first gear are interengaged with theteeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear.

According to one embodiment, the operable implant comprises an operationdevice and a body engaging portion, the operation device comprises anelectrical motor comprising a static part comprising a plurality ofcoils, and a movable part comprising a plurality of magnets, such thatsequential energizing of said coils magnetically propels the magnets andthus propels the movable part. The operation device further comprises anenclosure adapted to hermetically enclose the coils of the static part,such that a seal is created between the static part and the propelledmoving part with the included magnets, such that the coils of the staticpart are sealed from the bodily fluids, when implanted.

According to one embodiment, the external unit further comprises awireless communication unit adapted to at least one of: receive wirelesscommunication signals from the operable implant, and transmit wirelesscommunication signals to the operable implant.

A medical system for creating a magnetic connection between an externalunit and an operable implant is provided. The medical system comprises:an operable implant comprising at least one of; a magnet, a magneticmaterial, and a magnetizable material, and an external unit comprisingat least one of; an external permanent magnet and an external electromagnet, adapted to magnetically connect to at least one of: the magnet,the magnetic material and the magnetizable material of the operableimplant. The magnetic force of the external magnet can be arranged oradjusted such that the squeezing force on the skin of the patient can bearranged or adjusted. The medical system thus reduces the risk that theskin of the patient is injured.

According to one embodiment, the external magnet comprises at least onepermanent magnet, and the external unit further comprises: a skincontacting portion, and an adjustment device for adjusting the distancebetween or position of the permanent magnet in relation to the skincontacting portion.

According to one embodiment, the operable implant comprises: at leastone of; a first magnet, a first portion of magnetic material and a firstportion of magnetizable material, and at least one of: a second magnet,a second portion of magnetic material, and a second portion ofmagnetizable material. The external unit comprises: at least one firstmagnet or first electro magnet, and at least a second magnet or secondelectro magnet, at least one of; the first magnet, portion of magneticmaterial and magnetizable material of the operable implant is adapted tobe attracted by the first magnet or first electro magnet of the externalunit, and at least one of; the second magnet, portion of magneticmaterial and magnetizable material of the operable implant may beadapted to be repelled by the second magnet or second electro magnet ofthe external unit for balancing the squeezing force on the skin of thepatient.

According to one embodiment, the external unit is adapted to create, indifferent positions or at different times in the same position, a firstand second magnetic field having different polarity. The operableimplant may be adapted to create, in different positions, a first andsecond magnetic field having different polarity, wherein the firstmagnetic field is adapted to decrease the attracting force between theoperable implant and the external unit, caused the second magneticfield, such that the squeezing effect on the patient's skin is reduced.

According to one embodiment, the external unit comprises at least oneelectro magnet, and the external unit comprises a control unit forcontrolling the magnetic force of the electro magnet.

According to one embodiment, the medical system is adapted to transfermoving force from the external unit to the operable implant by means ofmagnetic connection, the external unit comprises an external drive unitadapted to create a moving magnetic field adapted to magneticallyconnect to the operable implant for transferring force from the externaldrive unit to at least one of; a magnet, a magnetic material and amagnetizable material of the operable implant.

According to one embodiment, the medical system is adapted to transfer arotating force through the skin of the patient, and the external driveunit comprises an external rotating structure comprising at least oneof; at least one permanent magnet and at least one electro magnet forcreating a rotating magnetic field adapted to magnetically connect to aninternal rotating structure, such that the internal rotating structurerotates along with the external rotating structure. The squeezing forceon the skin of the patient exerted by the magnets of the internal andexternal rotating structures may be adjusted such that rotating forcecan be transferred without excessive force to the patient's skin.

According to one embodiment, the external rotating structure has alarger diameter than the internal rotating structure, and the magnetsare arranged such that the radial force, enabling the magnets of theinternal rotating structure to rotate along with the magnets of theexternal rotating structure, is greater than the axial forces pressingthe internal structure against the external structure.

According one embodiment the external unit is adapted to create arotating magnetic field comprising both the first and second magneticfield according to any of the embodiments herein, being present in atleast one of the following alternatives;

1. the first magnetic field being created at least when rotating theexternal rotating structure and comprising at least one of; an angularlyintermittent first magnetic field, a central first magnetic field and aperipheral substantially continuous first magnetic field, wherein thefirst magnetic field is additionally creating at least a part of amagnetic coupling force allowing rotation of the internal rotatingstructure to join in at least one of; the rotational movement of theexternal rotating structure and the rotational movement of the magneticfield created by the rotational structure, wherein the force squeezingthe skin of the patient is reduced by the first magnetic field,

2. the first magnetic field being created by one or more negativepermanent magnets placed both on the internal and external rotatingstructure and comprising at least one of; an angularly intermittentfirst magnetic field, a central first magnetic field, and a peripheralsubstantially continuous first magnetic field, wherein the firstmagnetic field is additionally creating at least a part of a magneticcoupling force allowing rotation of the internal rotating structure tojoin in at least one of; the rotational movement of the externalrotating structure and the rotational movement of the magnetic fieldcreated by the rotational structure when standing still, wherein theforce squeezing the skin of the patient is reduced by the first magneticfield, and

3. the first magnetic field being created by one or more negativepermanent magnets placed both on the internal and external rotatingstructure, creating a repelling magnetic force between the internal andexternal rotating structure and the permanent magnets is adapted tocreate at least one of; an angularly intermittent first magnetic field,a central first magnetic field and a peripheral substantially continuousfirst magnetic field,

4. the first magnetic field being caused by one or more negativepermanent magnets placed on at the internal rotating structure, thepermanent magnets adapted to create at least one of; an angularlyintermittent second magnetic fields, a central second magnetic field anda peripheral substantially continuous second magnetic field, themagnetic field caused by the internal rotating structure is adapted tocreate a magnetic coupling force towards the external unit,

5. the second magnetic field being adapted to be created by the externalstructure comprising at least one of; two or more coils and two or morepositive permanent magnets, adapted to cause at least one of; anangularly intermittent second magnetic fields, a central second magneticfield and a peripheral substantially continuous second magnetic field,and at least one of; when having two or more permanent magnets, theexternal rotating structure rotating to cause rotation of the internalrotating structure because of the rotating magnetic field according toembodiment 7 causing a magnetic coupling force, and when having two ormore coils, the external rotating structure will stand still while themagnetic field of the external rotating structure rotates bysuccessively energize the coils causing rotation of the internalrotating structure because of the rotating magnetic field, and causingat least a part of a magnetic coupling force enabling the rotation ofthe internal rotating structure,

6. both the second and first magnetic fields being adapted to be createdat least partially by the external structure comprising at least one of;one or more coils, one or more positive permanent magnets and one ormore negative permanent magnets, adapted to cause at least one of; anangularly intermittent second and first magnetic fields, a centralsecond or first magnetic field and a peripheral substantially continuoussecond or first magnetic field, and wherein both the second and firstmagnetic fields are created by one or more negative permanent magnetsplaced on the internal rotating structure, the permanent magnets areadapted to create at least one of; an angularly intermittent secondmagnetic fields, a central second magnetic field and a peripheralsubstantially continuous second magnetic field, the magnetic fieldscreated by the internal rotating structure being adapted to create amagnetic coupling force towards the external unit, in at least one ofthe following alternatives; when having two or more positive permanentmagnets in magnetic coupling with two or more negative permanent magnetsof the internal structure, the external rotating structure will rotateto cause rotation of the internal rotating structure because of therotating magnetic field creating at least a part of a magnetic couplingforce, when having two or more negative permanent magnets in magneticcoupling with two or more negative permanent magnets of the internalstructure, the external rotating structure will rotate to cause rotationof the internal rotating structure because of the rotating magneticfield causing at least a part of a magnetic coupling force, and whenhaving two or more coils in magnetic coupling with two or more negativepermanent magnets of the internal structure, the external rotatingstructure will stand still and the magnetic field of the externalrotating structure will rotate by successively energize the coils tocause rotation of the internal rotating structure because of therotating magnetic field, and creating at least a part of a magneticcoupling force enabling the rotation of the internal rotating structure,and

7. both the second and first magnetic field being adapted to be rotatedat least partially by the internal structure, comprising at least oneof; one or more coils, one or more positive permanent magnets and one ormore negative permanent magnets, adapted to create at least one of; anangularly intermittent second and first magnetic fields, a centralsecond or first magnetic field and a peripheral substantially continuoussecond or first magnetic field.

According to one embodiment, the internal rotating structure comprisesan internal spherical cap, and the magnet or magnetic material of theinternal rotating structure is positioned on the outside of saidinternal spherical cap. The external rotating structure comprises anexternal spherical cap, and the magnet of the external rotatingstructure is positioned on the inside of said external spherical cap,such that rotating force can be transferred radially by means of themagnetic connection between the internal and external spherical caps.

According to one embodiment, the medical system according to any one ofthe embodiments further comprising an implantable electrical generatorcomprising: at least one movable generator portion comprises at leastone generator magnet adapted to magnetically connect to at least one ofthe; magnet, magnetic material and magnetizable material of the operableimplant, such that the movement of the at least one of magnet, magneticmaterial and magnetizable material; moves the movable generator portionor is the generator portion, and at least one coil in magneticconnection with the at least one generator magnet, such that electricalcurrent is induced in the coil by the movement of the movable generatorportion in relation to the coil.

According to one embodiment, the movable generator portion is adapted toperform rotating movements.

According to one embodiment, the implantable electrical generator is animplantable rotational electrical generator, and the movable generatorportion is adapted to perform rotating movement placed on the internalrotating structure, and the at least one coil is in magnetic connectionwith the at least one magnet, such that rotating movement of the movablegenerator portion induces current in the at least one coil.

According to one embodiment, the movable generator portion is adapted toperform reciprocating movements.

According to one embodiment, the implantable electrical generator is animplantable linear electrical generator, and the movable generatorportion is adapted to perform reciprocating movement. The at least onecoil is adapted to be in magnetic connection with the at least onemagnet, such that reciprocating movement of the movable generatorportion induces current in the at least one coil.

According to one embodiment, the external unit is adapted to create arotating magnetic field, and the operable implant comprises a pluralityof coils arranged in a circular configuration adapted to be in magneticconnection with the rotating magnetic field, such that the rotatingmagnetic field sequentially induces electrical current in the pluralityof coils.

In one embodiment, the external unit comprises a wireless energytransmitter, and the operable implant further comprises a wirelessenergy receiver, such that wireless energy can be transmitted from theexternal unit to the internal unit. The wireless energy transmitter maycomprise a wireless energy transmitting coil, and the wireless energyreceiver may comprise a wireless energy receiving coil.

The medical system may further comprise at least one battery adapted tostore electrical energy.

According to one embodiment, the external unit comprises a wirelesscommunication unit, and the medical system comprises a wirelesscommunication unit, such that the external unit and the operable implantcan communicate wirelessly.

The medical system may further comprise an enclosure adapted tohermetically enclose the operable implant, such that the operableimplant is sealed from the bodily fluids of the patient.

According to one embodiment, the operable implant may be adapted to beimplanted subcutaneously.

An operable implant is further provided. The operable implant comprisesan electrical motor adapted to transfer electrical energy to mechanicalwork, the electrical motor being adapted to output mechanical work of afirst force and velocity, and a gear system adapted to receivemechanical work of a first force and velocity from the electrical motoras input, and output mechanical work having a second different force andvelocity. The medical system further comprises a first force outputadapted to output mechanical work from the electrical motor, having afirst force and velocity, and a second force output adapted to outputmechanical work from the gear system, having a second force andvelocity.

According to one embodiment, the operable implant further comprises animplantable generator, and the first force output is connected to theimplantable generator for generating electrical current inside the bodyof the patient.

According to one embodiment, the operable implant further comprises anoperable body engaging portion connected to and operated by the secondforce output of the operation device.

The operable body engaging portion may be a hydraulically operable bodyengaging portion, and the operation device may further comprise ahydraulic pump for transferring hydraulic fluid to the hydraulicallyoperable body engaging portion.

The hydraulic pump of the operable implant may comprise a reservoiradapted to contain a hydraulic fluid, and the reservoir may comprise amovable wall portion for changing the volume of the reservoir, and themovable wall portion may be connected to the operation device, such thatthe operation device operates the movable wall portion.

The hydraulic pump may be a hydraulic pump selected from: at least onenon-valve pump, at least one valve pump, at least one peristaltic pump,at least one membrane pump, at least one gear pump, and at least onebellows pump.

According to one embodiment, at least one of the first and second forceoutput is connected to a threaded member adapted to transform theradially rotating force to an axially reciprocating force. The threadedmember may be directly or indirectly connected to the movable wallportion of a reservoir, for changing the volume of the reservoir.

The threaded member may be directly or indirectly mechanically connectedto the body engaging portion, such that the body engaging portion isoperated via the threaded member.

According to one embodiment, gear system of the operable implantcomprises: an operable element connected to the first force output, afirst gear having the shape of a hollow cylinder, comprising a firstnumber of teeth, on the peripheral outside thereof, and a second gearhaving the shape of a hollow cylinder, comprising a greater number ofteeth than the first gear, on the inside surface thereof, wherein theoperable element is adapted to engage the inside of the first gear, suchthat the outside of the first gear is pressed against the inside of thesecond gear such that the teeth of the first gear are interengaged withthe teeth of the second gear in at least one position interspaced bypositions at which the teeth are not interengaged, and wherein theoperation of the operable element advances the positions and therebycauses relative rotation between the first gear and the second gear, andwherein first gear is connected to the second force output foroutputting mechanical work having the second force and velocity.

According to one embodiment, the operation device further comprises asecond gear system, and the second gear system is adapted receivemechanical work of a second force and velocity from the first gearsystem as input, and output mechanical work having a third differentforce and velocity.

According to one embodiment, the operation device further comprises athird force output adapted to output mechanical work from the secondgear system, having a third force and velocity.

The second gear system may comprise: an operable element connected tothe second output, a first gear having the shape of a hollow cylinder,comprising a first number of teeth, on the peripheral outside thereof,and a second gear having the shape of a hollow cylinder, comprising agreater number of teeth than the first gear, on the inside surfacethereof, wherein the operable element is adapted to engage the inside ofthe first gear, such that the outside of the first gear is pressedagainst the inside of the second gear such that the teeth of the firstgear are interengaged with the teeth of the second gear in at least oneposition interspaced by positions at which the teeth are notinterengaged, and wherein the operation of the operable element advancesthe positions and thereby causes relative rotation between the firstgear and the second gear, and wherein first gear is connected to thethird force output for outputting mechanical work having the third forceand velocity.

According to one embodiment, the operable implant further comprises anenclosure adapted to enclose the operation device.

The enclosure may comprise a first and second penetration, the firstpenetration may be adapted for the first force output, and the secondpenetration may be adapted for the second force output.

According to one embodiment, the enclosure comprises a first, second andthird penetrating force output.

According to one embodiment, the enclosure comprises a first, second andthird penetration. The first penetration is adapted for the first forceoutput, the second penetration is adapted for the second force outputand the third penetration is adapted for the third force output. Thefirst force output may be connected to a first hydraulic pump foroperating a first body engaging portion, and the second force output maybe connected to a second hydraulic pump for operating a second bodyengaging portion.

According to one embodiment, the first force output comprises a firstrotatable shaft, and the second force output comprises a secondrotatable shaft.

The enclosure of may further comprise at least one of: a first sealingmember adapted to seal between the enclosure and the first rotatableshaft, and a second scaling member adapted to seal between the enclosureand the second rotatable shaft. The first and second sealing member mayallow rotation of the rotatable shafts.

The first rotatable shaft may be adapted to be positioned inside of thesecond rotatable shaft or the second rotatable shaft is adapted to bepositioned inside of the first rotatable shaft.

According to one embodiment, the first force output comprises a firstrotatable shaft, the second force output comprises a second rotatableshaft, and the third force output comprises a third rotatable shaft.

According to one embodiment, the enclosure comprises at least one of: afirst sealing member adapted to seal between the enclosure and the firstrotatable shaft, and a second sealing member adapted to seal between theenclosure and the second rotatable shaft, and a third sealing memberadapted to seal between the enclosure and the third rotatable shaft. Thefirst and second sealing members allow rotation of the rotatable shafts.

The first and second rotatable shaft may be adapted to be positionedinside of the third rotatable shaft or the second and third rotatableshaft may be adapted to be positioned inside of the first rotatableshaft or the first and third rotatable shaft is adapted to be positionedinside of the second rotatable shaft.

The operable implant may comprise at least one implantable battery,adapted to energize the electrical motor.

The operable implant may further comprise a receiving unit adapted toreceive wireless energy transmitted from outside the patient's body. Thereceiving unit may be adapted to charge a battery.

According to one embodiment, the electrical motor is an electrical motorselected from: an alternating current (AC) electrical motor, a directcurrent electrical motor, a linear electrical motor, an axial electricalmotor, a radial motor, a three-phase motor, a more than one-phase motor,a piezo-electric motor, a bimetal motor, and a memory metal motor.

The enclosure may comprise a material selected from: a carbon material,a boron material, a mixture of material, a Peek® material, an alloy ofmaterial, a metallic material, titanium, aluminum, a ceramic material, apolymer material, polyurethane, and Parylene® coated silicone.

The different aspects or any part of an aspect or different embodimentsor any part of an embodiment may all be combined in any possible way.Any method or any step of method may be seen also as an apparatusdescription, as well as, any apparatus embodiment, aspect or part ofaspect or part of embodiment may be seen as a method description and allmay be combined in any possible way down to the smallest detail. Anydetailed description should be interpreted in its broadest outline as ageneral summary description, and please note that any embodiment or partof embodiment as well as any method or part of method could be combinedin any way.

BRIEF DESCRIPTION OF DRAWINGS

The invention is now described, by way of example, with reference to theaccompanying drawing, in which:

FIG. 1a shows a schematic overview of an embodiment of the operableimplant and an external unit,

FIG. 1b shows a schematic overview of an embodiment of the operableimplant and an external unit,

FIG. 2a shows a sectional top view of an embodiment of a gear system,

FIG. 2b shows a sectional side view of an embodiment of a gear system,

FIG. 2c shows a schematic top view of an embodiment of a gear system,

FIG. 3a shows a sectional top view of an embodiment of a gear system,

FIG. 3b shows a sectional side view of an embodiment of a gear system,

FIG. 3c shows a schematic top view of an embodiment of a gear system,

FIG. 3d shows a schematic top view of an embodiment of a gear system,

FIG. 4 shows a sectional side view of an embodiment of an implantablehydraulic operation device,

FIG. 5 shows an elevated perspective view of an embodiment of animplantable hydraulic operation device in section,

FIG. 6 shows a sectional side view and a sectional top view of anembodiment of an implantable hydraulic operation device,

FIG. 7 shows a sectional side view and a sectional top view of anembodiment of an implantable hydraulic operation device,

FIG. 8 shows a sectional side view and a sectional top view of anembodiment of an implantable hydraulic operation device,

FIG. 9 shows a sectional side view and a sectional top view of anembodiment of an implantable hydraulic operation device,

FIG. 10a shows a sectional side view and a sectional top view of anembodiment of an implantable hydraulic operation device,

FIG. 10b shows an exploded, elevated perspective view of an embodimentof an implantable electrical motor,

FIG. 11a shows a sectional side view and a sectional top view of anembodiment of an implantable hydraulic operation device,

FIG. 11b shows an exploded, elevated perspective view of an embodimentof an implantable electrical motor,

FIG. 12 shows a sectional side view and a sectional top view of anembodiment of an implantable operation device,

FIGS. 13a-14b schematically shows embodiments in which a gear system iscomprised of a plurality of gear systems,

FIG. 15 shows a sectional side view of an embodiment of a hydraulicoperation device comprising two gear systems,

FIG. 16 shows a sectional side view of the left portion of an embodimentof a gear system comprised of two gear systems,

FIG. 17 shows an elevated perspective view of an embodiment of anembodiment of an implantable operation device comprising two gearsystems, in section,

FIG. 18a shows a sectional side view and a sectional top view of anembodiment of an implantable hydraulic operation device,

FIG. 18b shows an exploded, perspective side view of an embodiment of animplantable operation device, in section,

FIG. 19 shows an elevated perspective view of an embodiment of animplantable operation device, and an elevated perspective view of theimplantable operation device in section,

FIG. 20 shows a sectional side view and a top view of an embodiment ofan implantable operation device,

FIG. 21 shows a sectional side view of an embodiment of an implantablehydraulic operation device, comprising a magnetic coupling,

FIG. 22 shows a sectional side view of an embodiment of an implantableoperation device, comprising a magnetic coupling,

FIG. 23 shows a sectional top view of a peristaltic pump,

FIG. 24a shows an elevated perspective view of an implantable operationdevice comprising a peristaltic pump,

FIG. 24b shows a sectional side view of an implantable operation devicecomprising a peristaltic pump,

FIG. 25a shows a sectional side view of an implantable operation devicecomprising a peristaltic pump,

FIG. 25b shows a sectional top view of an implantable operation devicecomprising a peristaltic pump,

FIG. 26 shows an elevated perspective view of an embodiment of animplantable hydraulic operation device in section,

FIG. 27a shows a sectional side view of an implantable hydraulicoperation device, in a first state,

FIG. 27b shows a sectional side view of the implantable hydraulicoperation device of FIG. 27a , in a second state,

FIG. 28a shows a sectional side view of an implantable hydraulicoperation device,

FIG. 28b shows a sectional top view of an implantable hydraulicoperation device,

FIG. 29 shows an elevated perspective view of an implantable operationdevice, in section,

FIG. 30a shows an elevated perspective view of an implantable operationdevice, in a first state,

FIG. 30b shows an elevated perspective view of the implantable operationdevice of FIG. 30a , in a first state,

FIG. 31a shows an exploded perspective view of an implantable operationdevice comprising a start resistance delay,

FIG. 31b shows an exploded perspective view of an implantable operationdevice comprising a start resistance delay,

FIG. 31c shows an exploded perspective view of an implantable operationdevice comprising a start resistance delay,

FIG. 31d shows an exploded perspective view of an implantable operationdevice comprising a start resistance delay,

FIG. 31e shows an exploded perspective view of an implantable operationdevice comprising a coupling,

FIG. 32 shows a sectional side view of an implantable operation deviceplaced on the inside of the patient's skin, and an external unit forpowering the implantable operation device.

FIG. 33 shows a side view of wireless energy transmitter and animplantable wireless energy receiver,

FIG. 34 shows a side view an operable implant and a wireless energytransmitter,

FIG. 35a shows a sectional side view of wireless energy transmitter, anda sectional side view of a wireless energy receiver placed on the insideof the skin of the patient,

FIG. 35b shows a sectional side view of wireless energy transmitter, anda sectional side view of a wireless energy receiver placed on the insideof the skin of the patient,

FIG. 35c shows an alternative concept for wireless energy transmission,

FIG. 36 shows a side view an operable implant and a wireless energytransmitter,

FIG. 37 shows a side view an operable implant and a wireless energytransmitter,

FIGS. 38a-38c shows schematic side views illustrating principles forwireless energy transfer through the skin of a patient,

FIG. 39 shows a side view an operable implant and a wireless energytransmitter,

FIG. 40 shows a side view an operable implant and a wireless energytransmitter,

FIG. 41 shows schematic side view an operable implant,

FIG. 42 shows schematic side view an operable implant,

FIG. 43a shows a side view of an operable implant including a fixationand distance creating element,

FIG. 43b shows a side view of an operable implant including a fixationand distance creating element,

FIGS. 43c and 43d shows two distance elements making up a kit ofdistance elements,

FIG. 43e shows an adjustable distance element,

FIG. 44 shows an embodiment of the operable implant in which the bodyengaging portion is an injection device,

FIG. 45a shows an embodiment of the operable implant in which the bodyengaging portion is a constriction device,

FIG. 45b shows an embodiment of the operable implant in which the bodyengaging portion is two constriction devices,

FIG. 45c shows an embodiment of the operable implant in which the bodyengaging portion is a mechanical body engaging portion.

DETAILED DESCRIPTION

In the following a detailed description of embodiments of the inventionwill be given with reference to the accompanying drawings. It will beappreciated that the drawings are for illustration only and are not inany way restricting the scope of the invention. Thus, any references todirections, such as “up” or “down”, are only referring to the directionsshown in the figures. It should be noted that the features having thesame reference numerals have the same function, a feature in oneembodiment could thus be exchanged for a feature from another embodimenthaving the same reference numeral unless clearly contradictory. Thedescriptions of the features having the same reference numerals shouldthus be seen as complementing each other in describing the fundamentalidea of the feature and thereby showing the features versatility.

An operable implant is to be understood as any implant that could beoperated for performing a function in relation to the body of thepatient. To be operated includes the altering of the size and/or shapeof a portion of the implant, delivering an active or inactive substanceto the body of the patient, electrically stimulating a portion of thebody of the patient, sensing a physical or functional parameter of theoperable implant and/or a physiological or physical parameter of thepatient, communicating with an external unit on the outside of the skinof the patient and receiving or transmitting energy at the operableimplant, from an external unit. An operable implant could for example bea pacemaker unit, an external heart compression device, an apparatusassisting the pump function of the heart, such as an LVAD device, anoperable artificial heart valve, an implantable drug delivery device,such as an implantable device for delivering insulin or chemotherapeuticagents, a hydraulic, mechanic and/or electric constriction implant forconstricting for example: an intestine for treating anal incontinence,an intestine for handling a stoma, the urethra for treating urinaryincontinence, the bile duct for treating gall bladder malfunction, anoviduct for purpose of fertility control, the vas deference for thepurpose of potency control, a blood vessel for purpose of increasing theblood volume in an erectile tissue, or for the purpose of constrictingor restraining an aneurysm. An operable implant may further be anoperable implant for treating obesity, such as an operable volumefilling device for reducing the volume of the stomach, an operablegastric band for limiting the food passage way, or an operable implantfor stretching the stomach wall for creating a feeling of satiety. Theoperable implant may be an operable device for treating GERD an operablecosmetic implant, such as an operable breast augmentation implant, or animplant for adjusting or replacing any bone part of the body.Furthermore, the implant could be replacing an organ or part of anorgan, or the function thereof could be adjusted or replaced. Otherexamples of implants are implants treating impotence by implanted drugdelivery, implants affecting blood flow, vascular treatment deviceswhich may include blood clot removal, implants affecting fertilityand/or infertility, or implants adapted to move fluid inside the body.The above listed examples of an operable implant are to be seen asexamples not in any way limiting the possible application areas of theoperable implant.

Body engaging portion is to be understood as any part or portion of theoperable implant that is directly or indirectly connected to the body ofthe patient for performing a function in relation to the body of thepatient. The function could for example be pressing and/or pullingagainst a portion of the body of the patient, delivering a substance tothe body of the patient, collecting a sample from the body of thepatient, electrically stimulating a portion of the body of the patientand/or filling or emptying an implantable volume filling device with ahydraulic fluid.

A physical or functional parameter of the operable implant could forexample be an electrical parameter, such as voltage, current orimpedance, a parameter related to a fluid, such as pressure, flow rate,temperature, volume, weight or viscosity. The parameter could be relatedto energy received at the operable implant, energy delivered to the bodyof the patient, fluid received at the operable implant, fluid deliveredto the body of the patient, force exerted on the body of the patient ortime elapsed since an action was performed in relation to the body ofthe patient.

A physiological or physical parameter of the patient could for examplebe the blood pressure of the patient, a blood flow, a parameter relatedto blood saturation, a parameter related to an ischemia marker, atemperature of the body of the patient, a parameter related to muscleactivity or a parameter related to the activity of the gastro-intestinalsystem.

The enclosures referred to herein are in most instances adapted toseparate components of the operable implant from the bodily fluids whenimplanted. However, the enclosures may also be used for containing afluid or for separating a fluid used by the operable implant from othercomponents of the operable implant. The enclosures may be enclosuresmade from one of or a combination of: a carbon based material (such asgraphite, silicon carbide, or a carbon fiber material), a boronmaterial, a polymer material (such as silicone, Peek®, polyurethane,UHWPE or PTFE,), a metallic material (such as titanium, stainless steel,tantalum, platinum, niobium or aluminum), a ceramic material (such aszirconium dioxide, aluminum oxide and tungsten carbide) or glass. In anyinstance the enclosure should be made from a material with lowpermeability, such that migration of fluid through the walls of theenclosure is prevented.

The operation device in the operable implant may comprise an electricalmotor for transforming electrical energy into mechanical work. Theelectrical motor could for example be an alternating current (AC)electrical motor, such as a three-phase electrical motor (which may becontrolled using variable-frequency drive), a direct current (DC)electrical motor, a linear electrical motor, an AC or DC axialelectrical motor, a piezo-electric motor, a bimetal motor, or a memorymetal motor.

Generally, a medical system including an operable implant comprising animplantable body engaging portion and an implantable operation device,and components thereof, is described herein. The implantable operationdevice could be adapted to electrically, mechanically or hydraulicallyoperate the body engaging portion and could be powered by means ofwireless energy transfer from the outside of the body of the patient, orby means of an implantable battery adapted to store electrical energy inthe body of the patient. The operation device may comprise an electricalmotor for transferring electrical energy to mechanical work(force*distance) and the electrical motor may be connected to one ormore gear systems for altering the velocity and/or force/torque and/ordirection of the supplied force. The operable implant may additionallycomprise a communications unit for communicating with portions of theoperable implant, other operable implants and/or external units. Thecommunication with the external unit could comprise control signals fromthe external unit for controlling the operable implant or could comprisefeedback signals from the operable implant, which for example could besensor parameters such as physiological or physical sensor parametersrelated to the status of the body of the patient, or physical orfunctional parameters related to status of the operable implant.

FIGS. 1a and 1b shows overviews of a medical system including anoperable implant 100, adapted to be implanted in the body of a patient,and an external unit 200 for energizing and/or communicating with theoperable implant 100. The overviews in FIGS. 1a and 1b shows examples ofcomponents that may be included in the operable implant 100 and externalunit 200, respectively, and the embodiments are not to be seen ascomplete, just as the components shown in the figures are not the beregarded as essential for working the invention.

FIG. 1a shows an operable implant 100 implanted subcutaneously, underthe skin S, of the patient. The operable implant 100 comprises anoperation device 110 comprising a receiving unit 120 adapted to receivewireless energy or information from an external unit 200. The wirelessenergy may be in the form of an electromagnetic field transferredbetween a coil of the external unit 200 and a coil of the operableimplant 100, by means of the coils of the operable implant 100 andexternal unit 200 functioning as electrical conductors inductivelycoupled to each other, forming a transformer like circuit for thepurpose of transferring alternating electrical energy signals. Thewireless energy could in alternative embodiments be in the form of amoving magnetic field magnetically connected to a movable structure ofthe implantable operation device 110 comprising magnets or magneticmaterial, such that the movable structure of the operable implant movesalong with the moving magnetic field created in the external unit (suchas further described with reference to FIGS. 32-39). The receiving unit120 could further be a combination unit adapted to receive wirelessenergy both in the form a moving magnetic field affecting a movablestructure of the operation device, and as wireless energy generatingelectrical current on in the implantable operation device 110 foroperating a component consuming electrical energy, or charging a battery(such as 190 a, 190 b) for indirectly powering a component of theoperable implant 100 consuming electrical energy.

In the embodiment shown in FIG. 1a , the external unit 200 comprises anexternal drive unit 210 for creating a the mentioned rotating magneticfield by means of an external electrical motor 230 rotating an externalpart of a magnetic coupling 220 comprising a rotatable structurecomprising magnets or electromagnets, such that the rotation of therotatable structure by the operation of the external electrical motor230 creates the movable magnetic field (such as further disclosed e.g.with reference to FIG. 35-36).

The operation device 110 of the operable implant 100 further comprises adistance element 110 c adapted to create a distance between a first unit110 a of the operation device 110 comprising the main portion of thecomponents of the operation device 110, and a second unit 110 b of theoperation device 110, comprising the receiving unit 120. The distanceenables the receiving unit 120 to be substantially unaffected by thecomponents in the first unit 110 a, which could be components comprisingmagnetic or magnetizable material which may disturb the magnetic and/orelectromagnetic field transferring wireless energy between thetransmitting unit 220 and the receiving unit 120.

The distance element 110 c connecting the first and second units 110 a,110 b could comprises an electrical lead for transferring energy and/orinformation from the second unit 110 b to the first unit 110 a, and/or amechanical force transferring member adapted to transfer mechanicalforce from the second unit 110 b to the first unit 110 a. The mechanicalforce transferring member could for example be at least one of: arotating shaft for transferring rotational force, a flexible member fortransferring rotational force, such as a Bowden cable, a wire, a belt, arod, a worm gear, or a gear adapted to change the direction of therotational force received at the receiving unit substantially 90degrees, such as a Bevel gear.

The operation device of FIG. 1 further optionally comprises anelectrical motor 130 adapted to transform electrical energy to themechanical work. The electrical motor 130 may receive electrical energyfrom the receiving unit, directly transmitted from the external unit200, or may receive electrical energy stored in an implantable battery190. The electrical motor 130 may be omitted in embodiments where amoving force, such as a rotational moving force is received at thereceiving unit 120, directly transmitted from the external drive unit210. The electrical motor 130 could for example be an electrical motor130 selected from: an alternating current (AC) electrical motor, adirect current (DC) electrical motor, a linear electrical motor, anaxial electrical motor, a piezo-electric motor, a multiple phase motor,such as a three-phase motor, a bimetal motor, and a memory metal motor.

According to the overview shown in FIG. 1a , the force output of theelectrical motor 130 is in connection with a force input of a gearsystem 140. The gear system 140 is adapted to receive mechanical workhaving a first force and first velocity, and output mechanical workhaving a different second force and a different second velocity, suchthat the high velocity movement supplied by the electrical motor 130and/or the direct connection with the receiving unit 120 is transformedto low velocity movement with increased force.

The gear system 140 may for example comprise a gear system having theconfiguration such as any of the gear systems herein, such as the gearsystems disclosed with reference to FIGS. 2-16. In alternativeembodiments, it is conceivable that the gear system 140 comprises atransmission system of some other configuration, such as a conventionalgear wheel system, a worm gear system or a belt transmission system. Inthe embodiment shown in FIG. 1a , the gear system 140 is connected to aconnecting member 182, connecting the gear system 140 of the operationdevice 110 with the body engaging portion 180, for operating the bodyengaging portion. In the embodiment shown in FIG. 1a , the connectionbetween the gear system 140 and the body engaging portion 180 comprisesa mechanical connecting portion 181, such as a rotating shaft fortransferring rotational force, a rod, or a flexible member fortransferring rotational force, such as a Bowden cable.

The operation device may additionally comprise a generator 170 forgenerating electrical current (further described with reference to FIGS.36-40). The configuration of the operable implant 100 may be such thatthe generator 170 is placed between the receiving unit 120 and the gearunit 140, such that the generator 170 receives force at a high velocity.In an alternative embodiment in which there is no direct mechanicalconnection between the receiving unit 120 and the body engaging portion180, the gear system 140 may be entirely omitted.

The operable implant may comprise at least one implantable battery 190a, 190 b which could be used to operate or control the operable implant.The battery 190 a, 190 b could be used in combination with direct drivefrom the external drive unit 210. As an example, the patient may usedirect drive to operate the operable implant when at home, and batterypower when away from home, or in emergency situations. The battery 190a, 190 b could be adapted to power the operation of the operable implant100, and/or could be adapted to power a control and/or communicationunit. The battery 190 a, 190 b could be adapted to be charged, either bythe receiving unit receiving wireless energy, or by an implantablegenerator 170. The battery could be replaced by any form of energystoring device, such as a capacitor.

Referring again to FIG. 1a , the operable implant 100 additionallycomprises at least one implantable battery 190 a, 190 b, which may beplaced in a separate unit, such as the battery 190 a, or placed in theoperation device 110, such as the battery 190 b. The operable implant100 may comprise a lead 122 connecting the battery 190 a, 190 b to thereceiving unit 120, such that wireless energy received at the receivingunit 120 can be stored in the battery 190 a, 190 b, or a lead 172connecting the battery 190 a, 190 b to the electrical generator 170,such that electrical current generated in the generator 170 can bestored in the battery 190 a, 190 b. The at least one battery 190 a, 190b may be adapted to power at least one of: the control system 195, forcontrolling the operable implant 100 and the electrical motor 130. Afirst lead 192 connects the battery 190 a, 190 b to the control system195 and a second lead 132 connects the electrical motor 130 to thebattery 190 a, 190 b.

The control unit 195 may be contain elements for controlling theoperable implant 100, which may include controlling the electrical motor130, for example by means of adjusting the frequency of an alternatingcurrent supplied to the electrical motor 130, or by means of adjustingthe voltage supplied to the electrical motor 130. The control unit 195may be adapted to receive sensor input from one or more sensors of theoperable implant 100, which may be sensors adapted to monitor a physicalparameter of the operable implant 100, or a physiological parameter ofthe patient. The control unit 195 may in some embodiments be adapted tocontrol a hydraulic operation device by for example controlling theactuation of a valve or a movable wall portion of a reservoir. Thecontrol unit 195 may comprise a communication unit for communicatingwith an external unit 200, in which case the receiving unit 120 mayfurther comprise a unit for transmission of information, such thatinformation related to physical parameters or the operable implant,and/or physiological parameters related to the body of the patient, maybe communicated between the operable implant 100 and the external unit200. If necessary, the control unit may comprise a rectifier circuit forconverting alternating current received at the receiving unit to adirect current suitable for powering elements of the operable implant100 or for charging at least one battery 190 a, 190 b of the operableimplant 100. For the purpose of handling communication, informationand/or data, the control unit 195 may further comprise a demodulator anda microprocessor. The demodulator demodulates signals sent from theexternal unit 200 and the microprocessor may decode and/or interpret thereceived signals. The receiving unit 120 of the operable implant and thetransmitting unit 220 of the external unit 200 could be adapted tocommunicate by means of for example radio, IR (Infrared), ultrasonic,magnetic, inductive or capacitive signals.

The operable implant 100 or parts of the operable implant may beenclosed by an enclosure for separating components of the operableimplant 100 from the bodily fluids when implanted. However, theenclosure may also be used for containing a fluid, such as in areservoir, or for separating a fluid used by the operable implant 100,such as a lubricating fluid in the gear system, from other components ofthe operable implant 100. The enclosure may be made from a non-metallicand non-magnetic material not to affect the electromagnetic energytransfer between the external unit 200 and the operable implant 100. Theenclosure may be made from one of or a combination of: a carbon basedmaterial (such as graphite, silicon carbide, or a carbon fibermaterial), a boron material, a polymer material (such as silicone,Peek®, polyurethane, UHWPE or PTFE,), a metallic material (such astitanium, stainless steel, tantalum, platinum, niobium or aluminum), aceramic material (such as zirconium dioxide, aluminum oxide and tungstencarbide) or glass. In any instance the enclosure should be made from amaterial with low permeability, such that migration of fluid through thewalls of the enclosure is prevented.

Turning now to the external unit 200, the external unit 200 is adaptedto power, control and/or communicate with the operable implant 100. Theexternal unit 200 may comprise an external drive unit 210 which may beadapted to create a moving magnetic field adapted to be in magneticconnection with a magnet or magnetic material of the receiving unit 120of the operable implant 100, such that the creation of a moving magneticfield on the outside of the body of the patient operates the operableimplant 100 by the magnetic connection between the external drive unit210 and a movable structure of the operable implant 100. The movingmagnetic field may be created by an electrical motor 230 in connectionwith a moving structure comprising at least one magnet, which could bean electro magnet or permanent magnet. In alternative embodiments themoving magnetic field is created by the altering the magnetic field, forexample by alternating the current to an electromagnet, such that theforce supplied by the electromagnet alternates and thus is able tocreate a reciprocating movement of a magnetic or magnetic ormagnetizable material. The creation of a moving magnetic field isfurther described with reference to FIGS. 32-39.

The external unit 200 could be directly energized by a connection with apower outlet of the power grid, or may comprise at least one chargeableor disposable battery 290 which may be connected by means of a conduit292 to the drive unit 210 for powering the electrical motor 230 and/oran electromagnet. The external unit 200 may also comprise an externalcontrol/communication unit for communicating with thecontrol/communication unit 195 of the operable implant 100. The externalcontrol/communication unit may be adapted to receive control signalsfrom the operable implant and adjust the control of the external unit200 in response to the control signals received.

FIG. 1b shows an embodiment of the operable implant 100, which is to beseen as an alternative to the embodiment shown in FIG. 1a . Thedifference being that the embodiment of FIG. 1b is a specific hydraulicembodiment adapted to operate a hydraulically operable body engagingportion 180′ adapted to be connected to the operation device 110 bymeans of a connecting portion 182 comprising at least one conduit fortransferring hydraulic fluid from the operation device 110 to thehydraulically operable body engaging portion 180′.

The operation device 110 of the embodiment shown in FIG. 1b comprises ahydraulic pump 150 in connection with a reservoir 160 for holdinghydraulic fluid. The reservoir 160 may comprise at least one movablewall portion 163 which may constitute the hydraulic pump 150 (by themovable wall being operable, such as for example disclosed withreference to FIG. 4 or 5). In alternative embodiments, the hydraulicpump 150 could for example be a: non-valve pump, a pump comprising atleast one valve, a peristaltic pump, a membrane pump, a gear pump or abellows pump. The hydraulic pump 150 is operated by the connection witheither an implantable electrical motor 130, or a movable structureadapted to be operated from outside the body of the patient. Theconnection between the hydraulic pump 150 and the electrical motor 130or movable structure goes via a gear system 140 adapted to transform amovement of high velocity and low force to a movement of low velocityand high force.

The hydraulic body engaging portion 180′ could for example comprise ahydraulic constriction or restraining device, or a volume fillingdevice.

FIG. 2a shows an embodiment of an implantable gear system 140 foroperation in an operation device 110. The gear system 140 is adapted toreceive mechanical work having a first force and first velocity, andoutput mechanical work having a second, different force and a seconddifferent velocity. The gear system 140 comprises a force input 142connected to an operable element 143′ adapted to engage a first gear 144having the shape of a hollow cylinder, comprising a first number ofteeth 144 t, for example 160, on the peripheral outside thereof, and asecond gear 145 having the shape of a hollow cylinder, comprising agreater number of teeth 145 t than the first gear, for example 162, onthe inside surface thereof. The operable element 143′ is adapted toengage the inside 144 a of the first gear 144, such that the outside 144b of the first gear 144 is pressed against the inside 145 a of thesecond gear 145 such that the teeth 144 t of the first gear 144 areinterengaged with the teeth 145 t of the second gear 145 in position P₁interspaced by positions (for example the position P₂) at which theteeth are not interengaged. The operation of the operable element 143′advances the position P₁ and thereby causes relative rotation betweenthe first gear 144 and the second gear 145. In the embodiment shown inFIG. 2a , the second gear 145 comprises two more teeth 145 t than thefirst gear 144, resulting in the first gear 144 rotating 2/160 or 1/80of a revolution for each revolution that the operable element 143′performs, which results in a transmission of 80 times, i.e. the forceoutput (149 of FIG. 2b ) provides a force with 1/80 of the velocity and80 times the force, thus increasing the force which can be exerted on abody engaging portion 180 of the operable implant 100, by for example anelectrical motor, 80 times. In the embodiment shown in FIG. 2a theoperable element slides radially against the inner surface of the firstgear 144. For reducing the friction a lubricating fluid may be presentin the gear system, it is further conceivable that the operable element143′ or the surface against which the operable implant 143′ slides maycomprise a self lubricating material, such as Graphalloy, Nyliol orPTFE.

FIG. 2b shows the gear system 140 in a sectional side view, in anembodiment in which the gear system 140 comprises a third gear 146having an inside 146 a comprising the same amount of teeth 146 t as theoutside 144 b of the first gear 144. The teeth 146 t of the third gear146 are adapted to interengage with the teeth of the first gear 144 suchthat the third gear 146 rotates in relation to the second gear 145,along with the interengaged position (P₁ of FIG. 2a ). The third gear146 is in connection with a force output 149 of the gear system 140 bymeans of a radially extending connecting structure 147 for transferringforce from the third gear 146 to the force output 149.

FIG. 2c shows an alternative embodiment of the medical device, whereinthe operable element 143″ is adapted to engage the inside 144 a of thefirst gear 144 in two diametrically placed positions. The operableelement 143″ deflects the first gear 144 causing the first gear 144 toassume an oval shape, in an axial cross-section. The operable element143″ is adapted to maintain the first gear 144′ deflected, such that theteeth of the first gear 144 are interengaged with the teeth of thesecond gear 145 in two angularly spaced, diametrically placed, positionsP₁′ and P₁“. The two positions P₁′ and P₁” are interspaced by positionsat which the teeth are not interengaged, for example positions P₂′ andP₂″. In the embodiment of FIG. 2c , when the teeth of the first andsecond gears 144, 145 are interengaged in two positions, for the firstgear 144 to be equally deflected, thus forming an oval shape, thedifference in the number of teeth between the first gear 144 and thesecond gear 145 must be possible to divide by 2, such that the differingnumber of gears can be evenly distributed amongst the two areas betweenthe first and second gears 144, 145 with positions in which the teeth ofthe first and second gears 144, 145 are not interengaged. Mathematicallythis can be expressed as if the first gear has x teeth, the second gearmust have x+n*2 gears and the transmission provided by the gear system140 is then calculated as: transmission=x/(x+n*2). In alternativeembodiments (not shown) the operable element may be an operable elementadapted to deflect the first gear 144 such that the first and secondgears 144, 145 are interengaged at three, four or more positions, forthe purpose of creating an even deflection of the first gear 144, thedifference in the number of teeth between the first gear 144 and thesecond gear 145 must correspond to the number of contacting portions. Ina more general mathematical expression, the relation can be expressedsuch that the second gear must have x+n*m number of teeth, where n is aconstant selected based on the desired transmission and in is the numberof positions in which the teeth of the first and second gears areinterengaged.

FIG. 3a shows an embodiment in which the operable element comprises aplanet gear in which the force input 142 comprises a central gear inconnection with a first and second planet gear 143′″a, 143′″b, which inturn deflects the first gear 144 such that the teeth of the first gear144 interengages the teeth of the second gear 145 in a first and secondposition P₁′, P₁′. Analogously to what was previously described withreference to FIG. 2c , for the first gear 144′ to be equally deflected,thus forming an oval shape, the difference in the number of teethbetween the first gear 144 and the second gear 145 must be possible todivide by 2, such that the differing number of gears can be evenlydistributed amongst the two areas between the first and second gears144, 145 with positions in which the teeth of the first and second gears144, 145 are not interengaged.

The planetary gear of FIG. 3a further increases the transmission of thegear system with the transmission resulting from the difference in thenumber of teeth between the central gear 142 and the planetary gears143′″a, 143′″b, i.e. the total transmission of the gear system 140equals the transmission provided by the planetary gear plus thetransmission provided by the difference in number of teeth between thefirst gear 144 and the second gear 145.

FIG. 3b shows the gear system 140 in a sectional side view. In theembodiment shown in FIG. 3b , the gear system 140 also comprises a thirdgear 146 analogously to the third gear described with reference to FIG.2b , such that the third gear 146 rotates along with the first gear andthe interengaged positions P1′, P1″. The third gear 146 is in connectionwith a force output 149 of the gear system 140 by means of a radiallyextending connecting structure 147 for transferring force from the thirdgear 146 to the force output 149.

FIG. 3c shows an alternative embodiment of the planetary gear, in whichthe planetary gear only comprises one planet gear 143′″a in connectionwith the central gear 142. The embodiment functions similarly to theembodiment described with reference to FIG. 2a , the difference beingthat additional transmission is provided by the planetary gear.

FIG. 3d shows an embodiment in which the planetary gear comprises threeplanet gears 143′″a, 143′″b, 143′″c, each deflecting the first gear144′, such that the first gear 144 is pressed against the second gear145 in three angularly spaced (substantially with 120° between each)contacting positions P₁′, P₁″, P₁′″. Analogy to the other embodimentsdescribed, the difference in the number of teeth between the first gear144 and the second gear 145 must correspond to the number of contactingportions, i.e. in the embodiment shown in FIG. 3d , the difference mustbe possible to divide by three for the first gear 144 to be evenlydeflected.

In alternative embodiments, the gears of the planetary gears in any ofthe embodiments described with reference to FIGS. 3a-3d are gearswithout teeth and thus only uses friction to interengage each other. Thecentral gear is thus connected to, and propels, the planet gears bymeans of a friction based connection.

The gear system 140 of any of the embodiment in FIGS. 2a-3d could forexample be made of a metallic material, plastic material or ceramicmaterial. In one embodiment, the gear system is made from non metallicand/or non-magnetic material, such that the gear system does not affectthe energy transfer to an implantable energy receiver. The gear systemmay be lubricated with a biocompatible lubricant, such as hyaluronicacid, and may, for that purpose, be placed inside a reservoir adapted tohold a hydraulic fluid, which also may serve as a lubricant. The gearsystem may be encapsulated by an enclosure for preventing bodily fluidsfrom affecting the gear system and/or the in-growth of human tissue inthe gear system and/or the leakage of hydraulic and/or lubricatingfluids. The enclosure may be a non-metallic and/or non-magneticenclosure, such that the material of the enclosure does not affect theability of transferring wireless energy to a wireless energy receiver ofthe operable implant. The gear system may be encapsulated separately, ormay be encapsulated along with an electrical motor of the operationdevice, or additional components of the operation device.

FIG. 4 shows an embodiment of an implantable operation device 110 of anoperable implant 100 comprising the gear system 140 further describedwith reference to FIG. 3a . The gear system 140 comprises a force input142, which for example could be connected to an electrical motor adaptedto transfer electrical energy to mechanical work (such as any of theelectrical motors described herein). The force input 142 is connected tothe planetary gears 143′″a, 143′″b, which in turn operates the firstgear 144 of the gear system 140 (further described with reference toFIG. 4). A force output 149 is connected to the gear system 140 via thethird gear 146 of the gear system 140 and a radially extendingconnecting structure 147. The force output 149 is, in the embodimentdescribed in FIG. 4, a hollow shaft equipped with inner threads (notshown) adapted to engage outer threads of a threaded member 441, suchthat the interaction between the hollow shaft 149 and the threadedmember 441 transforms the radially rotating force generated by theoperation of the gear system 140, to a linear, axially reciprocatingforce. The threaded member 441 is in the embodiment shown in FIG. 4connected to a radially extending engaging member 444 adapted to engagea reservoir 160, adapted to contain a hydraulic fluid. In the embodimentshown in FIG. 4, the reservoir 160 is a torus shaped reservoir 160adapted to be compressed, such that the volume in the reservoirdecreases, pressing hydraulic fluid from the reservoir 160 to a fluidconduit 162 and further to a hydraulically operable body engagingportion 180 of the operable implant 100.

The operation device 110 further comprises a seat portion 445functioning as an anvil in relation to the compression of the reservoir160, and at the same time functioning as an enclosure, at leastpartially enclosing the gear system 140. The seat portion 445 connectsto a portion of the enclosure 442 adapted to enclose the force output149 and the threaded member 441, such that the threaded member 441 andforce output 149 is sealed from bodily fluids. The connection of theseat portion 445 with the portion of the enclosure 442 enclosing theforce output 149 and the threaded member 441 removes the need for a sealbetween the seat portion 445 and the force output 149 which facilitatesthe operation of gear system 140 and makes it possible for the gearsystem 140 to be hermetically enclosed. The portion of the enclosure 442enclosing the force output 149 and the threaded member 441 comprises apleated section 443 functioning as a bellow. The pleated section 443 isadapted to allow in-growth of fibrotic tissue without the mobility ofthe pleated section 443 being affected. The reservoir 160 is preferablymade from a resilient and/or elastic material, such as silicone, and maybe covered with a Parylene® coating to better resist the strain and wearinduced by the compression of the reservoir 160. The force input 142 maybe sealed against the bottom part of the enclosure, or alternatively, anoperation device, such as an electrical motor, may be placed in the samesealed environment, such that scaling between the force input 142 andthe enclosure is unnecessary.

FIG. 5 shows an embodiment of the operation device 110 in which the gearsystem is placed inside the reservoir 160′, such that the reservoir 160′at least partially surrounds the gear system 140. The embodiment shownin FIG. 5 further comprises an electrical motor 130 connected to theforce input 142 of the gear system 140. The force transfer between theelectrical motor 130 and the gear system 140 may comprises a shaft whichexits a first enclosure enclosing the electrical motor 130 and enters asecond enclosure enclosing the gear system 140 within the reservoir160′, in which case both enclosures needs to be rotatably penetrated bythe shaft, which creates friction at the seals. In an alternativeembodiment, the enclosure enclosing the electrical motor 130 and theenclosure enclosing the gear system 140 are connected, such that asingle enclosed space is created enclosing both the gear system 140 andthe electrical motor 130, in which case the force transferring shaftsdoes not need to be sealed. The enclosure 445′ thus sealingly connectsto the enclosure enclosing the electrical motor 130. The force output149 in connection with the threaded member 441 functions the same way asdescribed with reference to FIG. 4, with the difference that thethreaded member 441 is connected directly to a movable wall portion ofthe reservoir 160 such that the volume of the reservoir 160′ is changedby the threaded member 441 moving the movable wall portion. Thereservoir 160′ is connected to a fluid conduit 162′, such that the fluidin the reservoir 160′ is transported from the reservoir 160′, throughthe fluid conduit 162′ and to a hydraulically operable body engagingportion of the operable implant, such that the compression of thereservoir 160′ indirectly exerts a force on a portion of the body of thepatient.

In the embodiment shown in FIG. 5, the operable elements 143′″a, 143′″bare connected to the force input and the first gear by means offriction, i.e. the operable elements 143′″a, 143′″b does not compriseany teeth.

In some embodiments, the placing of the gear system inside the reservoirenables the gear system 140 to be lubricated by a hydraulic fluidcontained in the reservoir 160. The fluid may be a biocompatiblelubricating fluid, such as hyaluronic acid, an isotonic solution or aglycerol-based fluid etc.

The fundamental principle of the gear system 140 described above may beimplemented in combination with any of the operable implants herein. Theadvantages of the gear system 140 includes: low friction, hightransmission in a compact format, good precision, low noise and that thegear system 140 may function without lubrication.

FIG. 6 shows an embodiment of an implantable operation device 110 foroperating an operable implant. The operation device 110 comprises animplantable electrical motor comprising coils 132 and magnets 133.Energizing of the coils 132 generates a magnetic field by the electricalcurrent in the coil winding 132′ and the coil core 132″, magneticallyconnecting with the magnets 133. The magnets 133 are fixated to arotatable structure 135, such that sequential energizing of the coils132 propels the magnets 133 and causes the rotatable structure 135 torotate. The magnetic connection between the coils 132 and the magnets133 is positioned in the periphery of the operation device 110 such thatthe generated torque should be as large as possible. The rotatablestructure 135 comprises a radially extending portion 147 transferringthe force generated by the coils 132 and magnets 133 in the periphery ofthe operation device 110 to the force input 142 of the gear system inconnection with the operable elements 143′″a, 143′b. The operableelements engages and deflects the first gear 144 of the gear system 140such that the outside of the first gear 144 is pressed against theinside of the second gear 145 such that the teeth of the first gear 144are interengaged with the teeth of the second gear 145 in two positionsinterspaced by positions at which the teeth are not interengaged. Thesecond gear 145 has a greater number of teeth than the first gear 144,on the inside surface thereof, and the operation of the operable element143′″a, 143′″b thus advances the interengaged positions and therebycauses relative rotation between the first gear 144 and the second gear145.

The gear system further comprises a third gear 146 having the shape of ahollow cylinder. The inside of the third gear 146 comprises the sameamount of teeth as the outside of the first gear 144, and the teeth ofthe third gear 146 is adapted to interengage the teeth of the first gear144 such that the third gear 146 rotates in relation to the second gear145, along with the at least one interengaged position. The third gear146 is connected to a radially extending portion 147 connecting thethird gear 146 and the centrally placed force output 149 of the gearsystem.

Both the first 144, second 145 and third 146 gears have smallerdiameters than the portion of the rotatable structure 135 at which themagnets 133 are fixated, and smaller diameters than the portion of theenclosure 111 c fixating the coils 133. The gear system can thus beplaced inside of the electrical motor, such that the coils 132 andmagnets 133 axially overlaps the gear system. The electrical motor andgear system being placed in the same axial plane makes it possible topackage the operation device 110 in a thin enclosure 111, which forexample makes the operation device 110 suitable for subcutaneousimplantation.

The embodiment of the operation device described with reference to FIG.6 comprises a threaded member in the form of a worm shaft 441′ having afirst spiral groove in a first direction and a second spiral groove in asecond direction. The worm shaft 441′ is engaged by an operable portion446 connected to a radially extending engaging member 444 in turnadapted to compress the reservoir 160. The rotation of the worm shaft441′ causes reciprocation of the operable portion 446 in the spiralgrooves, by the operable portion 446 switching from engaging the firstspiral groove, to the operable portion 446 engaging the second spiralgroove at the end portions of the worm shaft 441′. The operation of theworm shaft 441′ thus makes the reservoir 160 perform a pumping actiontransporting fluid in the first and second direction in the fluidconduit 162.

In the operation device 110 of FIG. 11, the coils 132 are placed in asealed space further comprising a battery 190, adapted to power theelectrical motor, and a control unit 195 adapted to control theelectrical motor and/or additional operable elements of the operableimplant. The battery 190 and/or control unit 195 is in connection with alead 192 connecting the battery 190 and/or control unit 195 to awireless energy receiver and/or a wireless communication unit and/or anadditional battery 190 for supplying the operation device withadditional energy. In alternative embodiments, where the electricalmotor is powered directly from a wireless energy receiver, the battery190 is only adapted to power the control unit 195.

FIG. 7 shows an operation device 110 similar to the operation device 110shown with reference to FIG. 6, the difference being that in theoperation device in FIG. 7, the magnets 133 are fixated to a rotatablestructure 135 comprising a radially extending portion 147 adapted totransfer the force from the periphery of the rotatable structure 135 tothe center of the rotatable structure 135 below the electrical motor andthe gear system. The radially extending portion 147 transferring forceto the force input 142 of the gear system, which in turn engages theoperable elements 143′″a, 143′″b.

In the embodiment of FIG. 7, the coils 132 are placed and sealed in anindividual coil enclosure 131, such that the coils 132 are furtherisolated from the bodily fluids of the patient and/or from lubricatingfluids used in the gear system and/or from hydraulic fluids adapted totransfer force from the reservoir 160 to a hydraulically operable bodyengaging portion, through the fluid conduit 162.

FIG. 8 shows yet an alternative embodiment of an operation device 110similar to the operation device 110 shown with reference to FIGS. 6 and7. In the embodiment shown with reference to FIG. 8, the rotatablestructure 135 comprising the magnets 133 is adapted to be propelled bycoils 132 mounted to a portion 111 c of the enclosure 111 having aperipheral diameter larger than the diameter of the rotatable structure135 where the magnets 133 are mounted. The coils 132 are thus placedradially outside the magnets 133 and are sealed from the rest of theoperation device 110 and from the bodily fluids of the patient by meansof a coil enclosure 131. The rotatable structure 135 is connected to aforce input 142 in the center of the rotatable structure, which in turnis adapted to engage the operable elements 143′″a, 143′″b of the gearsystem (as described in further detail in other embodiments herein). Theembodiment shown in FIG. 8 places all rotating parts of the operationdevice 110 centrally in the operation device 110 which further insulatesthe rotating parts of the operation device 110, such that noise createdby the moving parts are less likely to propagate through the enclosure111 of the operation device 110 and the body of the patient.

FIG. 9 shows yet an alternative embodiment of the operation device, inwhich the magnets 133 are integrated in the operable elements 143′″a,143′″b of the operation device 110. The operable elements 143′″a, 143′″bare rotatably connected to a connecting structure 143 c and engages anddeflects the first gear 144 of the gear system as the magneticattraction force generated by the coils sequentially attracts themagnets 133 propelling the operable elements 143′″a, 143′″b. The portionof the operable elements 143′″a, 143′″b to which the magnets 133 areconnected have a larger diameter than the portion of the operableelements 143′″a, 143′″b engaging the first gear 144 of the gear system,such that the magnets 133 can be placed in close connection with thecoils 132. The distance between the coils 132 and the magnets 133 couldfor example be as little as one of 50 nm, 100 nm, 200 μm, 400 μm, 600nm, 800 μm, 1 mm, 2 mm, 3 mm, or 5 mm, depending on the overalldimensions of the operation device 110 and the magnetic force created bythe coils 132.

FIGS. 10a and 10b shows and embodiment of an operation device similar tothe embodiments shown with reference to FIGS. 6-9. The differencebetween the embodiments of FIGS. 6 and 10 a is that the embodiment ofFIG. 10a comprises an axial electrical motor 130′ adapted to propel theforce input 142 of the gear system. The axial electrical motor 130′comprises a set of coils 132 circularly distributed around a rotationalaxis of the electrical motor 130′ and a set of magnets 133 connected toa radially extending rotatable structure 135 axially overlapping themagnets 133, such that sequential energizing of the coils 132magnetically axially propels the magnets 133 and causes rotation of therotatable structure 135 connected to the force input 142 of the gearsystem in connection with the operable elements 143′″a, 143′″b, which inthe embodiments shown in FIG. 10a is planetary gears 143′″a, 143′″b. Thegear system and the axial electrical motor 130′ are positionedcoaxially, along the rotational axis of electrical motor 130′.

The operable elements 143′″a, 143′″b engages and deflects the first gear144 of the gear system such that the outside of the first gear 144 ispressed against the inside of the second gear 145 such that the teeth ofthe first gear 144 are interengaged with the teeth of the second gear145 in two positions interspaced by positions at which the teeth are notinterengaged. The second gear 145 has a greater number of teeth than thefirst gear 144, on the inside surface thereof, and the operation of theoperable element 143′″a, 143′″b thus advances the interengaged positionsand thereby causes relative rotation between the first gear 144 and thesecond gear 145.

The force output 149 of the gear system generates a reciprocating forcecompressing a reservoir 160, in the same manner as described in furtherdetail with reference to FIGS. 4 and 5. The embodiment of FIG. 10afurther comprises a sealed space below the axial electrical motor 130′housing a battery 190, adapted to power the axial electrical motor 130′,and a control unit 195 adapted to control the axial electrical motor130′ and/or additional operable elements of the operable implant. Thebattery 190 and/or control unit 195 is in connection with a lead 192connecting the battery 190 and/or control unit 195 to the coils 132 forsequentially energizing the coils 132 and thereby operating the axialelectrical motor 130′.

FIG. 10b shows the rotatable structure 133, to which the magnets 133 andforce input 142 of the gear system is fixated, the rotatable structure135 is a non-metallic disc, such that the individual magnets 133 areunaffected by their fixation to the rotatable structure 135. FIG. 10balso shows the coils 132 comprising the coil winding 132′ and the coilcore 132″ connected to a core structure 132 s adapted to position themagnets 133 and act as a magnetic interconnect between the cores 132″ ofeach of the coils 132. The coils 132 are circularly distributed aroundthe rotational axis of the operation device 110 and connected to thecore structure 132 s, such that the cores 132″ of the individual coils132, and the helix of the windings 132′ extends axially, parallel to therotational axis of the electrical motor and gear system.

FIG. 11a shows an embodiment similar to the embodiment shown in FIG. 10a, the difference being the axial electrical motor 130′ comprises twosets of circularly arranged coils 132, each arranged to a magnetizablecore structure 132 s magnetically connecting the cores 132″. Therotatable structure 135 comprising the magnets 133 and the two sets ofcoils 132 a, 132 b are coaxially positioned such that both the first andsecond sets of coils 132 a, 132 b overlaps the magnets of the rotatablestructure 135, such that the first set of coils 132 a propels themagnets 133 on the first side thereof, and the second set of coils 132 bpropels the magnets 133 on the second side thereof. In alternativeembodiments, it is conceivable that the rotatable structure/disc 135between the sets of coils 132 a, 132 b, comprises two sets of magnets,one set on each side, and it is conceivable that the first and secondset of magnets are radially offset, such that the lag of the electricalmotor can be made smaller. The battery 190 and/or control unit 195 is inconnection with a leads 192 connecting the battery 190 and/or controlunit 195 to the first and second sets of coils for sequentiallyenergizing the coils and thereby operating the axial electrical motor130′.

FIG. 12 shows an embodiment of an operation device 110 in which thecoils 132 are positioned inside of an enclosure 111 made from a castmaterial enclosing the coils 132 and the sealed space comprising thebattery 190 and control unit 195. The coils 132 are connected to thebattery 190 and control units 195 by means of leads 192, such that thecoils 132 can be sequentially energized for propelling the magnets 133.The magnets 133 are integrated in an operable element 143″″ fixated to aguide shaft 450 adapted to be guided by a guide recess 451. The coils132 are circularly distributed around the rotational axis of theoperation device 110 such that the cores 132″ of the individual coils132, and the helix of the windings 132′ extends axially, parallel to therotational axis of the operation device 110.

The operable element 143″″ is adapted to be propelled by the magneticconnection between the coils 132 in the enclosure 111 and the magnets133. The operable element 143″″ engages a first gear 144 having theshape of a hollow cylinder, comprising a first number of teeth 144 t,for example 160, on the peripheral outside thereof, and a second gear145 having the shape of a hollow cylinder, comprising a greater numberof teeth 145 t than the first gear 144, for example 162, on the insidesurface thereof. The outside of the first gear 144 is pressed againstthe inside of the second gear 145 such that the teeth 144 t of the firstgear 144 are interengaged with the teeth 145 t of the second gear 145 inposition P₁ interspaced by positions (for example the position P₂) atwhich the teeth 144 t, 144 t are not interengaged. The operation of theoperable element 143′ advances the position P₁ and thereby causesrelative rotation between the first gear 144 and the second gear 145.The gear system of the operation device of FIG. 12 further comprises athird gear 146 having an inside comprising the same amount of teeth 146t as the outside of the first gear 144. The teeth 146 t of the thirdgear 146 are adapted to interengage with the teeth 144 t of the firstgear 144 such that the third gear 146 rotates in relation to the secondgear 145, along with the interengaged position P₁. The third gear 146 isin connection with a force output 149 of the gear system 140 by means ofa radially extending connecting structure 147 for transferring forcefrom the third gear 146 to the force output 149.

The implantable operation device 110 described with reference to FIG. 12allows all electrical components, in particular the coils 132, battery190 and control unit 195 to be entirely sealed from the ambientenvironments, i.e. both from bodily fluids, when implanted, and from theadditional components of the operation device. Furthermore, it has fewmoving parts, and the magnets 133 can be entirely enclosed by theoperable element 143″″, which protects the magnets 133 from corrosionand wear. The surface of the enclosure 111 engaging the operable element143″″ is preferable made from a wear resistant material, such as aceramic material, and preferably is also the operable element 143″″enclosing the magnets 133 made from a wear resistant material such as aceramic material. The material of the enclosure being placed between thecoils 132 and the magnets 133 is preferably non-metallic andnon-magnetic, such that the magnetic connection between the coils 132and magnets 133 are minimally affected.

FIG. 13a schematically shows how two gear systems 140 a, 140 b may bepositioned in series, such that they function as a single gear systemhaving a transmission which equals the transmission of the first gear140 a system times the transmission of the second gear system 140 b. Thegear systems 140 a, 140 b may be the same type, e.g. gear systems of thetype disclosed with reference to FIGS. 2a -5. Alternatively, one of thegear systems 140 a, 140 b may be a gear system of the type for exampledescribed with reference to FIGS. 2a -5, and the other gear system 140a, 140 b, may be a gear system of a different type, such as a planetarygear system or a regular gear wheel system. The first and second gearsystems 140 a, 140 b, may have the same transmission, or may havedifferent transmission.

In the embodiment of FIG. 13a , the first and second gear systems arepositioned coaxially (further described for example with reference toFIG. 8) such that the first gear system 140 a can transfer force to thesecond gear system 140 b axially. The force transferred between thefirst and second gear systems are preferably rotational force, which maybe transferred centrally in both gear systems, peripherally in both gearsystems, or from the center in the first gear system 140 a to theperiphery of the second gear system 140 b.

FIG. 13b , schematically shows an alternative embodiment of the gearsystem in which a first and second gear system 140 a, 140 b areconnected in series. In the alternative embodiment shown in FIG. 13b ,the first gear system 140 a is positioned “inside” of the second gearsystem 140 b (further described for example with reference to FIG. 16).In the alternative shown, both the first and the second gear system 140a, 140 b are gear systems according of the type described with referenceto FIGS. 2a -5, the first gear of the first gear system is connected tothe operable element of the second gear system, such that the movementof the first gear of the first gear system relative to the second gearof the first gear system propels the operable element of the second gearsystem, 140 b. The first gear system may have the operable elementaccording to any one of the embodiments herein, which may, in theembodiments in which the operable element comprises a planetary gear,result in a total transmission being the transmission of the planetarygear times the transmission of the first gear system 140 a times thetransmission of the second gear system 140 b.

FIG. 14a shows yet another alternative, in which three gear systems arestacked coaxially and connected in series, such that the transmission isfurther enhanced. The total transmission thus results in thetransmission of the first gear system times the transmission of thesecond gear system times the transmission of the third gear system.Analogously, FIG. 14b shows a system where a first 140 a, second 140 band third 140 c gear systems placed radially inside of each other andcoupled in series in the same way as the first and second gear systemsare connected in for example FIG. 13b and FIG. 16.

FIG. 15 shows an embodiment of the operation device 110 of an operableimplant similar to the embodiment described with reference to FIG. 4,with the difference that the embodiment shown in FIG. 15 comprises afirst and second gear system 140 a, 140 b positioned coaxially, alongthe rotational axis of the first and second gear systems 140 a, 140 band connected in series. Both the first and second gear systems 140 a,140 b comprises force inputs 142 a, 142 b propelling the operableelements 143″a, 143′″b being part of a planetary gear system. Theoperable elements, 143′″a, 143′″b in turn engages a first gear 144having the shape of a hollow cylinder, comprising a first number ofteeth, on the peripheral outside thereof. The first gear 144 has adeflectable wall adapted to be engaged and deflected by the two operableelements 143′″a, 143′″b, such that the outside of the first gear 144 ispressed against the inside of the second gear 145 such that the teeth ofthe first gear 144 are interengaged with the teeth of the second gear145 in two positions interspaced by positions at which the teeth are notinterengaged. The second gear 145 has a greater number of teeth than thefirst gear 144, on the inside surface thereof, and the operation of theoperable element 143′″a, 143′″b thus advances the interengaged positionsand thereby causes relative rotation between the first gear 144 and thesecond gear 145.

The first and second gear systems 140 a, 140 b further comprises a thirdgear 146 having the shape of a hollow cylinder. The inside 146 a of thethird gear 146 comprises the same amount of teeth as the outside of thefirst gear 144, and the teeth of the third gear 146 is adapted tointerengage the teeth of the first gear 144 such that the third gear 146rotates in relation to the second gear 145, along with the at least oneinterengaged position. The third gear 146 of the first gear system 140 ais connected to a radially extending connecting structure connecting theperipherally placed third gear 146 and the centrally placed force output149 a of the first gear system/force input 142 b of the second gearsystem 140 b. The first and second gear systems 140 a, 140 b are thusconnected in series by the third gear 146 of the first gear system 140 abeing connected to the force input 142 b of the second gear system 140b.

In the embodiment shown in FIG. 15 the force output 149 b of the secondgear system 140 b comprises a hollow shaft connecting to a threadedmember 441 which in turn operates a reservoir 160. The details of theoperation of the threaded member 441 are further described withreference to FIG. 4. Even if the first en second gear systems 140 a, 140b are described in relation to a hydraulic embodiment having a torusshaped reservoir 160 changing volume for pushing hydraulic fluid to ahydraulically operable body engaging portion, the details of the firstand second gear systems 140 a, 140 b connected in series may be used inany of the other embodiments described herein. Examples of alternativeembodiments include: the threaded member 441 being in direct connectionwith a body engaging portion, which could be in direct connection withthe body of the patient, and the first and second gear systems 140 a,140 b being connected to a pump for pumping hydraulic fluid; the pumpcould for example be a peristaltic pump or a membrane pump.

The first and second gear systems 140 a, 140 b is preferable enclosed inthe same sealed spaced, such that the force transfer between the firstand second gear systems 140 a,140 b can take place without having totransfer force through a sealing. In the embodiment shown in FIG. 8 theforce input 142 a of the first gear system 140 a penetrates theenclosure, however, in alternative embodiments, an operation device,such as an electrical motor, is tightly fitted to the gear systemenclosure, or enclosed along with the first and/or second gear system140 a, 140 b, such that no penetrated sealing is required between thefirst and second gear systems 140 a, 140 b.

FIG. 16 shows an operation device 110 comprising an alternativeembodiment of the gear system 140, similar to the embodiment shown inFIG. 15. FIG. 16 depicts the left half of the operation device 110 insection. The operation device comprises a housing 111, which is a rigidpart for example made from a stiff polymer material, a ceramic materialor a metal. A portion of the housing 111 constitutes a coil enclosure131, enclosing a coil 132, such that the coil 132 is sealed from bodilyfluids and scar tissue when implanted. The coil 132 is one element of anelectrical motor further comprises magnets 133 mounted to a rotatablestructure 135 having a radially extending portion 147 adapted totransfer force from the periphery of the operation device to the centerthereof. The rotatable structure 135 is rotatably mounded to the housing110 by means of a first bearing Ba such that the rotatable structure canrotate in relation to the housing 110. The central portion of therotatable structure 135 constitutes the force input to the first gearsystem 140 a adapted to propel the operable element 143′″a such that theoperable element 143′″a engages the first gear 144 a of the first gearsystem 140 a causing the teeth of the first gear 144 a to interengagewith the teeth of the second and third gears 145 a, 146 a of the firstgear system 140 a. The second gear 145 a of the first gear system 140 ahas more teeth than the first gear 144 a of the first gear system 140 a,causing the contacting portions between the first 144 a and second gear145 a to rotate (as further described above). The third gear 146 a hasthe same amount of teeth as the first gear 144 a and thus rotates alongwith the contacting positions. The third gear 146 a is connected to aradially extending portion 147 adapted to transfer the force from theperiphery to the central portions of the operation device and to theforce input 140 a to the second gear system 140 b. The structurecomprising the third gear 146 a, the radially extending structure 147and the force input 142 b of the second gear system 140 b is rotatablyconnected to the force input 142 a of the first gear system 140 a bymeans of a bearing Bb, and the force output 149 c from the second gearsystem 140 b by means of a bearing Bc. The second gear system 140 boperates analogously to the first gear system 140 a, and a structurecomprising the third gear 146 b of the second gear system 140 b, aradially extending portion 147 and the force output of the second gearsystem 149 c is rotatably connected to the housing 110 of the operationdevice 110 by means of a bearing Bd.

In the operation device shown in FIG. 16, the sequential energizing ofthe coils 132 propels the magnets 133 connected to the rotatablestructure 135, which in turn propels the first gear system 140 a. Thefirst gear 140 a system is connected in series with the second gearsystem 140 b which in turn provides a force output 149 c which could beused to power a body engaging portion of the operable implant in whichthe operation device 110 is used. By the first and second gear systems140 a, 140 b being connected in series, the total transmission of theoperation device 110 equals the transmission of the first gear system140 a times the transmission of the second gear system 140 b. Thus, theforce output 149 c will output force at a velocity of: the velocity ofthe rotatable structure comprising the magnets 133 times thetransmission of the first gear system 140 a times the transmission ofthe second gear system 140 b.

FIG. 17 shows an embodiment of an operation device 110 similar to theoperation device described with reference to FIG. 16, with thedifference that the operation device of FIG. 17 has a first and secondforce output 149 a, 149 c extending out of the enclosure 111 of theoperation device 110, such that the operation device 110 can supplymechanical work of a first and second type, i.e. a first form ofmechanical work having a first force and velocity, and a second form ofmechanical work having a second force and velocity.

In further detail, the coils 132 enclosed in the coil enclosure 131 aresequentially energized, which propels the magnets 133 fixated to arotatable structure 135 connected to the force input 142 a of the firstgear system. The rotatable structure 135 is also connected to a forceoutput 149 a of the operation device 110 such that a high velocity forceoutput is provided from the operation device 110. The high velocityforce output 149 a may for example be coupled to a generator forgenerating electrical current inside of the body of the patient. As thefirst gear system is connected in series with a second gear system, thefirst gear system propels the second gear system which ultimatelyprovides force output by means of the third gear 146 b of the secondgear system, and thus a low velocity force output 149 c by mean of aconnection via a radially extending rotatable structure 147. The lowvelocity force output 149 c may for example be connected to a portion ofthe operable implant engaging the body of the patient and requiringmechanical work of a low velocity and high force.

FIG. 18a shows an embodiment of the operation device, in which a firstgear system 140 a is positioned radially inside of a second gear system140 b, such that the second gear system 140 b axially overlaps the firstgear system 140 a (axially in relation to the rotational axis of theoperation device 110. As in the operation devices described withreference to FIGS. 16 and 17, operation device comprises an electricalmotor comprising a coil 132, comprising a coil winding 132′ and a coilcore 132″, such as an iron core. The coil is adapted to be energized toproduce a magnetic field adapted to affect and propel magnets 133fixated to a rotatable structure 135. In alternative embodiments, themagnets 133 could be replaced by any magnetic material which could beattracted by the magnetic field created by the coils 132. The rotatablestructure 135 in turn propels the force input 142 a of the first gearsystem 140 a, engaging the operable elements 143′″a, 143′″b, which inturn engages the inside of the first gear 144 a of the first gearsystem, such that the first gear 144 a is deflected and operates thethird gear 146 a analogously to the gear system functionality describedabove. The third gear 146 a of the first gear system 140 a is connectedto a radially extending structure 147 which constitutes the operableelements 143:2 of the second gear system 140 b. The operable element143:2 of the second gear system 140 b engages the first gear 144 b ofthe second gear system 140 b having teeth interengaged with teeth of athird gear 146 b of the second gear system 140 b and functioninganalogously. The third gear 146 b of the second gear system 140 b is inturn connected to a radially extending structure 147 transferring forcefrom the periphery of the operation device to the center of theoperation device 110, to propel a force output 149 c of the second gearsystem 140 b. Having the electrical motor and the first and second gearsystems 140 a, 140 b in the same plane allows a very thin designsuitable for subcutaneous implantation.

The force output 149 c of the second gear system 140 b is in connectionwith a threaded member 441 transferring rotational force to linear,reciprocating force which operates a torus shaped reservoir 160, asfurther described with reference to FIG. 4.

The housing of the operation device 111 encapsulates the operationdevice such that bodily fluids do not affect the operation device 110.The housing/enclosure 111 could for example be made from a biocompatiblemetal material, such as titanium or tantalum, preventing the migrationof bodily fluids into the operation device 110. In alternativeembodiments, the enclosure 111 could be made from a ceramic material,such as silicon carbide or zirconium carbide, or a polymer material,such as UHWPE or PTFE, or glass. In any instance the enclosure should bemade from a material with low permeability, such that migration ofbodily fluids through the walls of the enclosure 111 is prevented.

In the embodiment shown in FIG. 18a , the coils 132 is additionallyenclosed in a coil enclosure 131, such that the coils 132 areadditionally sealed from the other components of the operation device110 and/or bodily fluids.

The operation device 110 of FIG. 18a further comprises a sealed spacecontaining a battery 190, adapted to power an electrical motor, and acontrol unit 195 adapted to control the electrical motor and additionaloperable elements of the operable implant. The battery 190 and/orcontrol unit 195 is in connection with a lead 192 connecting the battery190 and/or control unit 195 to a wireless energy receiver and/or awireless communication unit and/or an additional battery for supplyingthe operation device with additional energy. In alternative embodiments,where the electrical motor is powered directly from a wireless energyreceiver, the battery 190 may be adapted to only power the control unit195. The wireless energy receiver may in other embodiments be integratedand encapsulated in the same enclosure 111 encapsulating the operationdevice 110.

FIG. 18b shows the first and second gear systems and the electricalmotor of the operation device 110 of FIG. 11a , in an exploded view. Thelowermost piece is the static part of the operation device 110,comprising the second gear 145 a of the first gear system and the secondgear 145 b of the second gear system 145 b, the coils 132 of theelectrical motor, comprising the coil cores 132″ and the coil windings132′, and the coil enclosures 131, are adapted to hermetically enclosethe coils 132, such that the coils 132 are sealed from bodily fluidsand/or lubricants adapted to lubricate the first and/or second gearsystem and/or hydraulic fluids for transferring force from the operationdevice 110 to a hydraulically operable body engaging portion of theoperable implant (further described in relation to other embodimentsdescribed herein). Above the static part 132, 145 a, 145 b, therotatable structure 135 is depicted. The rotatable structure 135comprises the magnets 133 adapted to be in magnetic connection with thecoils 132, such that sequential energizing of the coils 132 propels themagnets 133 and thus the rotatable structure 135 to which the magnets133 are fixated. The rotatable structure 145 also comprises the forceinput 142 a to the first gear system 140 a, which is adapted to propelthe planetary gear 143′″ being the operable element 143:1 of the firstgear system 140 a, by means of interengaging teeth or friction. Theoperable element 143′″ engages and deflects the first gear 144 a of thefirst gear system 140 a such that the teeth 144 t on the outside of thefirst gear 144 a interengage the teeth 145 t on the inside of the secondgear 145 a of the first gear system, being part of the static part. Asthe first gear 144 a of the first gear system comprises fewer teeth 144t than second gear 145 b of the second gear system, the interengagingposition between the first and second gears 144 a, 145 a are advanced,and as the third gear 146 a of the first gear system comprises the sameamount of teeth 146 t as the first gear 144 a, the third gear 146 amoves along with the advancing positions. The third gear 146 a of thefirst gear system is an integrated part of the operable element 143:2 ofthe second gear system, thus also comprising the force output 149 b ofthe second gear system, and a radially extending structure 147connecting the third gear 146 a of the first gear system and the rollingoperable elements 143:2′ of the operable element 143:2.

The rolling operable elements 143:2′ of the operable element 143:2 ofthe second gear system engages and deflects the first gear 144 b of thesecond gear system, such that the second gear system propels the thirdgear 146 b of the second gear system analogously to the first gearsystem. The third gear 146 b of the second gear system is integrated ina structure (the uppermost structure depicted) further comprising aradially extending element 147 connecting the third gear 146 b the forceoutput 149 b of the second gear system (and of the operation device),such that the mechanical work generated by the electrical motor 132, 133can be outputted as rotational force through the force output 149 b.

In the embodiment shown in FIG. 18b the first and second gear systemshave the same transmission. However, it is conceivable that the secondgear system have a higher transmission than the first gear system, i.e.that the gears of the second gear system has more teeth than the gearsof the first gear system, while the difference between the number ofteeth of the first and second gears 144 a, 144 b, 145 a, 145 b of thefirst and second gear systems are the same. For example, the first gear144 a of the first gear system having 98 teeth, the second gear 145 a ofthe first gear system having 100 teeth, the first gear 144 b of thesecond gear system having 198 teeth and the second gear 144 b of thesecond gear system having 200 teeth, resulting in the first gear systemhaving a transmission of 1:50 (plus the transmission of the planetarygear system provided by the operable element) and the second gear systemhaving a transmission of 1:100. In some applications it may beadvantageous that the gears of the second gear system has the samenumber of teeth as the gears of the first gear system (thus beinglarger), as the gears of the second gear system is required to transferhigher force with lower velocity.

FIG. 19 shows an alternative embodiment of the operation device 110similar to the operation device described with reference to FIG. 18. Thedifference being the first gear system 140 a is the gear system placedin the periphery, while the second gear system 140 b is the gear systemplaced centrally. The coils 132 in the embodiment shown in FIG. 19 areplaced inside the rotatable structure 135 comprising the magnets 133.The rotatable structure 135 is in the embodiment shown in FIG. 19integrated with the operable element 143:1 of the first gear system 140a. The operable element 143:1, in the embodiment shown in FIG. 19comprises a rolling operable element 143:1′ adapted to engage the insideof the first gear 144 a for deflecting the first gear 144 a. Theinterengagement of the first gear 144 a and the third gear 146 a of thefirst gear system 140 a propels the third gear 146 a of the first gearsystem 140 a which is in connection with the force input 142 b adaptedto propel the operable elements 143′″, in turn deflecting the first gear144 b of the second gear system 140 b, for propelling the third gear 146b of the second gear system 140 b, serving as force output for theoperation device 110. The structure 131, 145 b enclosing the coils 132constitutes the static part of the operation device 110 and is directlyor indirectly connected to the second gear 145 a of the first gearsystem 140 a such that the second gear 145 a of the first gear system140 a is static along with the second gear 145 b of the second gearsystem 140 b and the coil enclosure 131.

FIG. 20 shows the operation device of FIG. 19, in section. The structure131, 145 b enclosing the coils 132 constitutes the static part of theoperation device 110 and is connected to the second gear 145 a of thefirst gear system 140 a such that the second gear 145 a of the firstgear system 140 a is static along with the second gear 145 b of thesecond gear system 140 b and the coil enclosure 131. In the embodimentof FIGS. 12 and 13, the entire lower portion 111′ of the enclosure 111rotates for transferring force from the periphery of the operationdevice 110 to the center of the operation device 110, and thus forms thefirst gear system 140 a to the second gear system 140 b. The operationdevice 110 may additionally be enclosed by an additional enclosure,preferably connected to the static portion of the operation device 131,145 b, 145 a, such that the rotatable lower portion of the enclosure111′ does not have to be in direct connection with the body of thepatient.

In the embodiment sown in FIG. 20, the force input 142 b of the secondgear system 140 b (being comprised in the same structure as the forceoutput 149 b of the first gear system) is rotatably fixated by a recessr in the structure comprising the force output 149 b of the second gearsystem 140 b, the third gear 146 b of the second gear system 140 b, anda radially extending rotatable structure 147 connecting the third gear146 b of the second gear system 140 b to the force output 149 c of theof the second gear system 140 b.

FIG. 21 shows an embodiment of an implantable operation device 110comprising a magnetic force coupling 460 connected to the force input142 to the operation device 110. The magnetic force coupling 460comprises a first set of magnets 461 a, 461 b connected to an externalrotatable structure 463 comprising a radially extending portion 147connecting the rotating structure to the force output 149 a of anelectrical motor (not shown). The operation of the electrical motorrotates the force output 149 a which in turn propels the rotatablestructure 463 comprising the magnets 461 a, 461 b. The external magnets461 a, 461 b are in magnetic connection with the internal magnets 462 a,462 b connected to an internal rotatable structure 464 connected to theforce input 142 of a gear system 140. The external rotatable structure463 is placed radially on the outside of the internal rotatablestructure 464. The gear system 140 is the gear system further describedwith reference to e.g. FIG. 3b or 4. The force output 149 b of the gearsystem 140, in the embodiment shown in FIG. 21 operates an operablereservoir 160, for moving a hydraulic fluid from the reservoir 160 to ahydraulically operable body engaging portion connected to the reservoir160 by means of a fluid conduit 162. The operation of the operablereservoir 160 is further described with reference to FIG. 4. Inalternative embodiments, the force output 149 b may be connected to ahydraulic pump for transporting hydraulic fluid to the hydraulicallyoperable body engaging portion, such as for example a non-valve pump, avalve pump, a peristaltic pump, a membrane pump, a gear pump, or abellows pump. In addition, it is equally conceivable that the forceoutput 149 b of the gear system 140 is connected to some other means foroperating a body engaging portion, such as mechanical means.

The internal rotatable structure 464 is enclosed by an enclosure 111 m,such that the gear system 140 and the internal rotatable structure 464is hermetically enclosed and thus sealed from bodily fluids whenimplanted. The enclosure 111 m is preferably made from a non-metallicand non-magnetic material, such as a polymer material, such as UHMWPE,PEEK or PUR. However, it is also conceivable that the enclosure is madefrom any of: a carbon material, a boron material, a mixture of material,an alloy of material, a metallic material, titanium, aluminum, a ceramicmaterial, a polymer material, silicone, and Parylene® coated silicone.

The internal and/or external magnets 461 a, 461 b, 462 a, 462 b couldfor example be neodymium magnets, it is also conceivable that one of theinternal set of magnets 431 a, 461 b and the external set of magnets 462a, 462 b are magnets, and one of the internal set of magnets 461 a, 461b and the external set of magnets 462 a, 462 b only are made from amaterial adapted to be attracted by magnetic force, such as iron.

The electrical motor (not shown) connected to the external rotatablestructure 463 could for example be an alternating current (AC)electrical motor, a direct current electrical motor, a linear electricalmotor, an axial electrical motor, a piezo-electric motor, a three-phasemotor, a more than one-phase motor, a bimetal motor, and a memory metalmotor.

FIG. 22 shows an embodiment of an implantable operation device 110comprising a magnetic force coupling 470 connected to the force output149 b of an operation device 110, or more specifically to a force output149 b of a second gear system 140 b of the operation device 110. Theoperation device 110 providing the force to the force output 149 b is anoperation device 110 comprising an electrical motor 130 and a first andsecond gear system 140 a, 140 b, and is further described with referenceto FIG. 18a . However, a magnetic force coupling 470 may be added to anyof the operation devices disclosed herein, such as the operation devicesdisclosed with reference to FIGS. 6,7,8 9, 10, 11, 12, 16, 17, and 19.The operation of the operation device 110 rotates the force output 149 bwhich in turn propels the rotatable structure 464 comprising the magnets471 a, 471 b. The internal magnets 471 a, 471 b are in magneticconnection with the external magnets 472 a, 472 b connected to anexternal rotatable structure 463 connected to the force output 149 c.The external rotatable structure 463 is placed radially on the outsideof the internal rotatable structure 464.

The force output 149 c is in direct or indirect connection with anoperable body engaging portion, such that the operation device 110operates the operable body engaging portion via the magnetic forcecoupling 470. The internal rotatable structure 464 is enclosed by anenclosure 111 m, such that the operation device 110, i.e. the electricalmotor 130 and the first and second gear systems 140 a, 140 b, ishermetically enclosed and thus scaled from bodily fluids when implanted.The enclosure 111 m is preferably made from a non-metallic and nonmagnetic material, such as a polymer material, such as UHMWPE, PEEK orPUR. However, it is also conceivable that the enclosure 111 m is madefrom any of: a carbon material, a boron material, a mixture of material,an alloy of material, a metallic material, titanium, aluminum, a ceramicmaterial, a polymer material, silicone, and Parylene® coated silicone.

In the operation device 110 of FIG. 22, a sealed spaced is furtherprovided in the operation device enclosure 111 comprising a battery 190,adapted to power the electrical motor 130, and a control unit 195adapted to control the electrical motor 130 and/or additional operableelements of the operable implant.

The battery 190 and/or control unit 195 is in connection with a lead 192connecting the battery 190 and/or control unit 195 to a wireless energyreceiver and/or a wireless communication unit and/or an additionalbattery 190 for supplying the operation device with additional energy.The electrical motor 130 is a alternating current (AC) electrical motor130, and the control unit 195 comprises a frequency converter foraltering the frequency of an alternating current for controlling the ACelectrical motor. In alternative embodiments, where the electrical motor130 is powered directly from a wireless energy receiver, the battery 190is only adapted to power the control unit 195.

FIG. 23 shows an embodiment of an implantable peristaltic pump 150′adapted pump and thus transport a hydraulic fluid to a hydraulicallyoperable body engaging portion of an operable implant. The peristalticpump 150′ could be adapted to be connected to force output of anoperation device, such as any of the operation devices (110) disclosedherein. The implantable peristaltic pump 150′ comprises a deflectablehollow member 152 for fluid transportation, in form of a tubing madefrom a resilient material, such as an elastomeric polymer material, suchas silicone, Parylene® coated silicone, NBR, Hypalon, Viton, PVC, EPDM,Polyurethane or Natural Rubber. The deflectable hollow member 152 isadapted to be deflected by an operable compression member 153 a-153 c orwiper, adapted to engage and compress the hollow member 152, and thustransport the hydraulic fluid. The compression members 153 a-153 c, arepropelled by the operation device. The hollow member 152 is placedinside a peristaltic pump housing 151, such that the hollow member 152is compressed between the operable compression members 153 a-153 c. Theperistaltic pump 150′ enables the hydraulic fluid to be completelyseparated from the bodily fluids, such that the hydraulic fluid can betransported from a fluid reservoir (such as the fluid reservoirs 160described in other embodiments herein) to a hydraulically operable bodyengaging portion without the risk of leakage.

FIGS. 24a and 24b shows an implantable operation device 110 comprising aperistaltic hydraulic pump 150′ similar to the peristaltic pump 150′described with reference to FIG. 23. The difference being that theoperable compression members comprises rollers 153 a′-153 c′ rotatablyconnected to a rotatable structure 155 propelled by a force output 149of the gear system 140. The gear system 140 is in turn connected to anelectrical motor 130 adapted to propel the gear system 140. Theelectrical motor 130 is in the embodiment described in FIG. 24 energizedby a battery 190 enclosed in an enclosure 111 enclosing the operationdevice 110.

The rollers 153 a′-153 c′ sequentially compresses the hollow member 152and thus transports fluid in the hollow member 152. In FIG. 24b theoperation device with the peristaltic pump 150′ is shown in section,such that the hollow member 152 is shown in its non-compressed state 152and its compressed state 152′, when the roller 153 c′ compresses thehollow member 152′ against the housing 151 of the peristaltic pump 150′.The electrical motor 130 and the gear system 140 could for example be anelectrical motor (130) and gear system (140) described in any of theembodiments herein. As the rollers 153 a′-153 c′ roll against the hollowmember 152 they do not wear or rupture the hollow member 152 in the sameway as a wiping or sliding operable compression member risks to do,which increases the life span of the hollow member 152.

FIGS. 25a and 25b shows an embodiment of an operation device 110comprising a peristaltic hydraulic pump, such as the peristaltic pumpfurther disclosed with reference to FIG. 23. The peristaltic pumpcomprising a hollow member 152 for fluid transportation, and operablecompression members 153 a, 153 b 153 c adapted to engage and compressthe hollow member 152. In the operation device shown in FIGS. 25a and25b , the compression members 153 a-153 c are connected to the forceoutput 149 of a gear system in connection with an electrical motor, bothplaced inside of the peristaltic pump. The electrical motor and gearsystem are similar to the electrical motor and gear system describedwith reference to FIG. 7, the difference being that the force output 149of the gear system of FIGS. 25a and 25b is connected to, and propels theoperable compression member 153 a, such that the electrical motoroperates the peristaltic pump via the gear system.

In further detail, the coils 132 of the electrical motor is connected bymeans of leads (not shown) to a control unit 195 which in turn isconnected to a battery 190. The control unit generates an alternatingcurrent (AC) by means of a converter which is used to energize thecoils. The alternating current thus sequentially energizes the coils 132such that a propagating magnetic field is created in the coils 132propelling the magnets 133 fixated to a rotatable structure 135. Therotatable structure 135 is in turn connected to the force input 142 ofthe gear system, such that the force input propels the operable elements143′″a, 143′″b deflecting the first gear 144 of the gear system andcausing relative rotation between the third gear 146 and the second gear145 which propels the force output 149 of the gear system which is indirect connection with the operable compression members 153 a, 153 b,153 c.

The hollow member 152 thus forms ¾ of a loop encircling the electricalmotor and the gear system and the compressing members 153 a-153 ccompresses the hollow member 152 towards the outer periphery of the loopand against the housing 151 which is a portion of the operation deviceenclosure 111.

The hollow member 152 is sealed by means of a sealing member 157, suchas a glue, against the enclosure of the operation device 111 such thatthe entire operation device is hermetically enclosed and sealed againstthe bodily fluids at the same time as the hydraulic system ishermetically enclosed in the hollow member and thus no hydraulic fluidcould leak to the body of the patient and/or to the operation device.Furthermore, the embodiment of FIGS. 25a and 25b , having theperistaltic pump being placed in the same plane as the electrical motorand the gear system, enables the entire operation device to be made verythin and thus being suitable for subcutaneous implantation.

FIG. 26 shows an embodiment of the operation device in which theoperation device comprises a hydraulic pump comprising a torus shapedreservoir 160 adapted to contain a hydraulic fluid. The torus shapedreservoir 160 is adapted to be compressed by a radially extendingengaging member 444 operated by the portion of the operation device 110′comprising en electrical motor and gear system, such as any of thecombinations of electrical motors gear systems described herein. Theembodiment of the operation device shown in FIG. 26 is very similar tothe embodiment described for example with reference to FIG. 4. The maindifference is that the embodiment shown in FIG. 26 further comprises anadditional enclosure 161 enclosing the torus shaped reservoir 160 andthe radially extending engaging member 444. The additional enclosure 161comprises a sealing member 167 adapted to seal between the additionalenclosure and the fluid conduit adapted to transport the hydraulic fluidfrom the torus shaped reservoir 160 to a hydraulically operable bodyengaging portion, for operating the hydraulically operable body engagingportion. The additional enclosure further seals the operation device 110from the bodily fluids and reduces the risk that fibrotic tissuein-growth affects the operation of the operation device 110.

FIG. 27a shows an operation device 110 according to an embodiment inwhich the operation device comprises an operable reservoir 160 adaptedto contain a hydraulic fluid. The electrical motor and double gearsystem portion of the operation device is similar to what is operationdevice described with reference to FIGS. 18b and 19. However, theoperation device of FIGS. 27a and 27b additionally comprises a circularreservoir 160 encircling the operation device. The circular reservoir160 comprises a movable wall portion adapted to compress and expand thecircular reservoir 160, thereby altering the volume of the reservoir160. The third gear 146 b of the second gear system, rotating along withthe interengaging portions between the first and second gears 144 b, 145b (such as further described with reference to FIGS. 27a and 27b ) isconnected to an operation spiral 472 adapted to engage a radially fixedcorresponding operation spiral 473, such that the operation of theoperation spiral 472 in relation to the radially fixed operation spiral473 moves the radially fixed operation spiral axially, such that thereservoir 160 is compressed.

FIG. 27a shows the operation device 110 in a state in which theoperation spiral 473 is aligned in relation to the correspondingradially fixated operation spiral, such that the two spirals 472, 473match and forms a structure being as thin as possible and thuscompressing the reservoir 160 minimally i.e. the thinnest portion of theoperation spiral 472 b engages the thickest portion of the radiallyfixed operation spiral 473 a.

FIG. 27b shows the operation device 110 in a state in which theoperation spiral 472 has performed close to a full rotation, such thatthe thickest portion of the operation spiral 472 a engages the thickestportion of the radially fixed operation spiral 473 a, such that the twospirals “mismatch” and forms a structure being as thick as possible andthus compressing the reservoir 160 maximally. One revolution of theoperation spiral 472 thus alters the state of the reservoir 160 frombeing fully expanded to fully compressed, which enables transportationof hydraulic fluid from the reservoir to the hydraulically operable bodyengaging portion by the operation device 110.

The circular reservoir 160 is compressible by means of a pleated portion443 enabling the reservoir 160 to be made from a resilient butnon-elastic material, such as a non-elastomeric polymer material.

FIGS. 28a and 28b shows an embodiment of an operation device 110 similarto the embodiment of the operation device 110 shown with reference toFIGS. 27a and 27b . The electrical motor 130 portion and the gearsystems 140 portions are identical. The difference in the operationdevice is that the third gear 146 of the second (outer) gear system isconnected to radially operable operation members 482 a, 482 b adapted toengage two reservoirs 160 a, 160 b, each radially extending alongsubstantially half the circumference of the operation device 110. Thefirst and second radially extending reservoirs 160 a, 160 b compriseswalls having pleated portions 442 enabling the compression of thereservoirs 160 a, 160 b by the radial movement of the radially operableoperation members 482 a, 482 b. A first end 160 a′ of the firstreservoir 160 a is connected to a first radially operable operationmember 482 a, and a second end 160 a″ of the first reservoir 160 a isconnected to a first radially fixated member 483 a. Analogously, a firstend 160 b′ of the second reservoir 160 b is connected to a secondradially operable operation member 482 b, and a second end 160 b″ of thesecond reservoir 160 b is connected to a second radially fixated member483 b. The first and second reservoirs 160 a, 160 b are compressedbetween the radially operable operation members 482 a, 482 b and theradially fixated members 483 a, 483 b, respectively, such that thevolume in the first and second reservoirs is changed. As the volume inthe reservoirs decrease, the fluid contained in the reservoirs istransported from the reservoirs 160 a, 160 b to the body engagingportions via fluid conduits 162.

FIG. 29 shows an implantable operation device 110 for operating a bodyengaging portion of an operable hydraulic implant in section. Theoperation device comprises a reservoir 160 a for holding a hydraulicfluid. The reservoir 160 a comprises a movable wall portion 163 aadapted to move to alter the volume of the reservoir 160 a and therebytransport hydraulic fluid from the reservoir 160 a to the body engagingportion. The operation device further comprising an operation member444, extending radially and being connected to the movable wall portion163 a, such that operation of the operation member 444 alters the volumeof the reservoir 160 a. The operation device 110 further comprises aflexible enclosure 111 adapted to have its volume altered by changingthe outer size and shape of the enclosure and enclose the movable wallportion 163 a and the operation member 444. The movable wall portion 163a is adapted to move inside of the enclosure 111, such that the volumeof the reservoir 160 a can be changed by affecting the outer dimensionsof the operation device 110 to a lesser extent and in the oppositedirection than the change of volume of the reservoir 160 a by themovement of the movable wall portion 163 a inside of the enclosure 111.The reservoir 160 a further comprises a manual portion (reservoir) 160 bcomprising a movable wall portion 163 c adapted to be compressed bymanual force from outside of the body of the patient, such that fluidcan be transported from the reservoir 160 b via a second fluid conduit162 b to the body engaging portion by means of manual force, fortemporarily increasing the hydraulic pressure at the body engagingportion. The manual portion 160 b could for example be used inemergencies if an implantable battery runs out of power, or if a patientwould like to override an automatic system.

In further detail, the hydraulic operation 110 device shown in FIG. 29comprises an electrical motor 130, which in the embodiment shown is analternating current (AC) electrical motor comprising a plurality ofcoils 132 connected to a static structure, and a plurality of magnets133 connected to a rotatable structure 135. The plurality of coils 132and plurality of magnets 133 are magnetically connected such sequentialenergizing of the coils 132 propels the magnets 133 and thus therotatable structure 135. The peripheral surface of the rotatablestructure 135 comprises or acts like a pulley 138 a engaging a belt 137,such that operation of the electrical motor 130 propels the belt 137.

The belt 137 is further connected to a second pulley 138 b connected toa radially extending portion 147 connecting the pulley 138 a to a forceinput 142 of a gear system 140, being the gear system described inseveral embodiments herein, for example with reference to FIGS. 4-7. Theforce input 142 propels the operable elements 143′″, which in turnengages and deflects the first gear 144 having teeth interengaging thesecond gear 145 and third gear 146. The first gear 144 having less teeththan the second gear 145 creating a rotation of the interengagingpositions between the first and second gears 144, 145. The third gear146 has the same amount of teeth as the first gear 144 and thus rotatesalong with the interengaged positions. The third gear 146 is connectedto the force output 149 of the gear system 140 by means of a radiallyextending portion 147. The force output 149 is a threaded shaft adaptedto engage inner threads of a threaded member 441 of a radially extendingoperation member 444 adapted to engage a movable wall portion 163 a ofthe reservoir 160 a. The interaction between the threaded shaft 149 andthe threaded member 441 transforms the radially rotating force generatedby the operation of the gear system 140, to a linear, axiallyreciprocating force. The average thickness of the movable wall portion163 a is less than the average thickness of the movable outer wallportion 163 b of the reservoir 160 a. The reservoir 160 a is connectedto a fluid conduit 162 a for transporting fluid from the fluid reservoir160 a to the body engaging portion of the hydraulically operable implant110.

The radially extending operation member 444 presses the movable wallportion 163 a upwards for compressing the fluid reservoir 160 a, avacuum is created beneath the radially extending operation member 444which forces the outer movable wall 163 b to move downwards thuscompresses the reservoir 160 a from the outside. The operation thuschanges the external size of the operation device 110 by moving amovable wall 163 a within the operation device 110.

Placed coaxially and on top of the reservoir 160 a is a second manualreservoir 160 b. The manual reservoir 160 b is enclosed by the wall ofthe first reservoir 160 a and an external movable wall 163 c adapted tobe compressed by manual operation from the outside of the body of thepatient. The second manual reservoir 160 b comprises a second fluidconduit 162 b adapted to connect the second manual reservoir 160 b tothe body engaging portion, such that manual compression of the reservoir160 b transports fluid from the second manual reservoir 160 b to thebody engaging portion. The manual portion could for example be used inemergencies if an implantable battery runs out of power, or if a patientwould like to override an automatic system.

In alternative embodiments, the implantable operation device 110 mayadditionally comprise an injection port for injecting hydraulic fluidinto the reservoir from outside the body of the patient. The injectionport may be an integrated portion of the reservoir or may be connectedto the reservoir by means of a fluid conduit. The injection port may beadapted to refill or calibrate the fluid amount in the first reservoirand/or in the manual reservoir 160 b.

The implantable operation device may be implanted subcutaneously and mayadditionally comprise a fixation member (such as the fixations memberdescribed with reference to FIGS. 43a-43e ) adapted to directly orindirectly fixate at least a portion of the implantable operation deviceto at least one muscular fascia and/or at least one bone fascia and/orat least one cortical bone layer and/or at least one muscular layerand/or fibrotic tissue and/or any part of the abdominal wall and/or anypart of the subcutaneous space and its surroundings in the body.

In alternative embodiments, the electrical motor 130 of the operationdevice may be an electrical motor selected from: an alternating current(AC) electrical motor, a direct current electrical motor, a linearelectrical motor, an axial electrical motor, a piezo-electric motor, atwo or more phase motor, a three phase motor, a bimetal motor, and amemory metal motor.

FIG. 30a shows the hydraulic operation device 110 shown in FIG. 29 in anexternal view, when the reservoirs (160 a, 160 b in FIG. 29) are fullyexpanded i.e. the movable walls 163 b, 163 c are not compressed. Theenclosure 111 is made from a resilient polymer material, such asParylene® coated silicone. In addition to the first and second fluidconduits 162 a, 162 b penetrating the enclosure 111, the enclosure 111further comprises a lead inlet 192 i for allowing an electrical lead topenetrate the enclosure 111 for powering the electrical motor (130 ofFIG. 29). The electrical lead may be connected to a battery locatedoutside of the enclosure 111, or a receiving unit for receiving wirelessenergy (further disclosed in other embodiments herein) located outsideof the enclosure 111.

FIG. 30b shows the hydraulic operation device 110 in its fullycompressed state, when the volumes of both the first and secondreservoirs are compressed to a minimum. In the embodiment shown, theperipheral side wall of the first reservoir (160 a of FIG. 29) comprisesa pleated portion 443 adapted to enable the compression of the firstreservoir.

FIG. 31a-31d shows different embodiments of start resistance delaymembers positioned between the force output of the electrical motor andthe body engaging portion. The start resistance delay members areadapted to enable the electrical motor to operate with at least one of;less force or less friction induced by the direct or indirect connectionwith the body engaging portion for a time period, such that theelectrical motor can start with less resistance.

FIG. 31a shows an embodiment of the operation device 110 comprising astart resistance delay 440 positioned between the force output 149 of anelectrical motor/gear system 130/140 and a delay force output 149 d,which in turn is directly or indirectly connected to a body engagingportion of the operable implant. The electrical motor/gear system unit130/140 shown in FIG. 31a is identical to the electrical motor gearsystem unit described with reference to FIG. 7.

The force output 149 of the electrical motor/gear system 130/140 isconnected to the center of a helical spiral spring 492 which in turn isconnected to rotatable delay structure 491 such that the rotation of theforce output 149 to which the center of the helical spiral spring 492 isconnected at a connection point 493 gradually starts rotating therotatable delay structure 491 to which the spring 492 is connected. Whenthe force output 149 of the gear system 140 has rotated a sufficientnumber of revolutions, the spring 492 is sufficiently winded such thatthe rotatable delay structure 491 rotates along with the force output149 of the gear system 140. During the revolutions required for thespring 492 to start driving the rotatable delay structure 491 theelectrical motor has rotated a sufficient amount of revolutions to havea torque large enough to directly or indirectly propel the body engagingportion to which the delay force output is connected. The amount ofrevolutions that the start resistance delay 440 should delay theelectrical motor 130 depends on the time it takes for the electricalmotor 130 to reach the velocity needed to create sufficient torque. Thespring 492 could for example be a steel spring or a polymer spring madefrom a resilient polymer material.

FIG. 31b shows an alternative embodiment of an operation device 110,similar to the embodiment shown in FIG. 31a , the difference being thatin the embodiment shown in FIG. 31b , the spring 492 creating the delayis positioned between the electrical motor 130 and the gear system,centrally inside the gear system. The force input 142 of the gear systemis connected to the force output of the electrical motor 130. The centerof the helix of the spring 492 is fixated to the force input 142, suchthat the operation of the electrical motor 130 propels the central partof the spring 492 causing the winding of the spring 492 graduallyleading to force being transferred from the force input to the operableelements 143 a, 143 b connected to a rotatable structure 491 to whichthe peripheral part of the spring 492 is fixated at a connection point493. When the spring 492 is sufficiently winded, the operation of theelectrical motor 130, via the gear system, propels operable elements 143a, 143 b engaging and deflecting the first gear 144 such that the thirdgear 146 rotates along with the interengaging positions between thefirst 144 and second/third gears (145 not shown) and 146. In theembodiment of FIG. 31b , the electrical motor 130 is allowed to reachsufficient velocity for propelling the operable elements 143 a, 143 bbefore the force input of the gear system is transferring force to theoperable elements 143 a, 143 b.

FIG. 31c shows an embodiment of the operation device 110 comprising astart resistance delay 440 being a friction clutch operated by means ofcentrifugal force. The start resistance delay 440 is positioned betweenthe force output 149 of an electrical motor/gear system 130/140 and adelay force output 149 d, which in turn is directly or indirectlyconnected to a body engaging portion of the operable implant. Theelectrical motor/gear system unit 130/140 shown in FIG. 31a is identicalto the electrical motor gear system unit described with reference toFIG. 7. The start resistance delay 440 is fixated to the force output149 of the gear system by means of a connecting portion 497 comprising arecess or hole engaging the force output 149. From the connectingportion 497, two sleeves 496′ extends radially in opposite directions.In the sleeves, piston-like shafts 496″ are positioned. The portion ofthe piston-like shaft 496″ directed towards the connecting portion 497is connected to a tension coil spring 499 which in the other endconnected to the connecting portion 497. The portion of the piston-likeshaft 496″ directed towards the periphery of the operation device 110 isconnected to arc-shaped rotatable frication elements 495 comprisingfriction surfaces 495 s adapted to engage corresponding frictionsurfaces of the inner surface of a delay structure 491. When thearc-shaped rotatable frication elements 495 stands still, the tensioncoil springs 499 pulls the arc-shaped rotatable frication elements 495towards the center of the operation device 110 such that the fricationsurfaces 495 s do not engage the friction surfaces of the inner surfacesof the delay structure 491, however as the arc-shaped rotatablefrication elements 495 starts to rotate, the arc-shaped rotatablefrication elements 495 are pushed radially outwards, by means ofcentrifugal force, towards the inner surface of the delay structure 491,such that the friction surface 495 s of the arc-shaped rotatablefrication elements 495 engage the friction surfaces of the delaystructure 491, such that the delay structure 491 is propelled. The delaystructure 491 is connected to the delay force output 149 d of theoperation device, which in turn is directly or indirectly connected tothe body engaging portion of the operable implant.

FIG. 31d shows an embodiment of the operation device 110 comprising astart resistance delay 440 operated by means of a mechanical play P. Thestart resistance delay 440 is positioned between the force output 149 ofan electrical motor/gear system 130/140 and a delay force output 149 d,which in turn is directly or indirectly connected to a body engagingportion of the operable implant 110. The electrical motor/gear systemunit 130/140 shown in FIG. 31a is identical to the electrical motor gearsystem unit described with reference to FIG. 7. The start resistancedelay 440 is fixated to the force output 149 of the gear system by meansof a connecting portion 497 comprising a recess or hole engaging theforce output 149. The connecting portion 497 is connected to asemi-cylindrical disc 498 b connected to a quarter-cylindrical disc 498a by means of a spring 499. The position of the quarter-cylindrical disc498 a in relation to the semi-cylindrical disc 498 b creates a radialmechanical play P between the quarter-cylindrical disc 498 a and thesemi-cylindrical disc 498 b corresponding to a ¼ of a revolution of thesemi-cylindrical disc 498 b. The mechanical play P enables the forceoutput 149 of the gear system to perform ¼ of a revolution, which inturn enables the electrical motor to perform ¼ of a revolution times thetransmission of the gear system. The quarter-cylindrical disc 498 a isfixated to the delay structure 191 by means of a fixation surface F′ ofthe quarter-cylindrical disc 498 a being fixated to a fixation surfaceF″ of the quarter-cylindrical disc 498 a. In the embodiment shown inFIG. 31d , the spring 499 returns the semi-cylindrical disc 498 a to thestarting position when the electrical motor is stopped i.e. resettingthe start resistance delay 440, however, it is equally conceivable thatthe spring is replaced by the electrical motor being programmed toperform a number of reverse revolutions after being stopped forresetting the start resistance delay 440.

FIG. 31e shows a coupling which may be used in connection with any ofthe embodiments of operation devices herein. The coupling could be usedto limit the force output of the operation device 110 for safetyreasons, such that the risk of damage to any parts of the deviceoperated by the operation device is reduced. The coupling comprisesprotruding members 486 protruding from the force output of the gearsystem. The coupling further comprises a disc shaped member comprisingrecesses 487 which correspond to the protruding members 486 of the gearsystem. The protruding members 487 are rounded for enabling theprotruding members to slip out of the recesses, lifting the disk shapedmember against the action of the spring 499 and thus separating the gearsystem from the force output 149 d of the disc shaped member.

FIGS. 32-40 shows alternative methods and devices for transferring forceand/or electrical energy from the outside of the body of the patient tothe inside of the body of the patient. The different methods and devicesmay be used with the operable implants of any of the embodiments herein.For example, the use of a reciprocating magnetic field for the transferof wireless energy reduces the losses in energy transfer, as no energyis consumed with the sheer forces arising from the transfer if arotating magnetic field.

FIG. 32 shows an operation device 110 for an operable implant, whenbeing implanted subcutaneously in the abdominal region of a patient i.e.beneath the skin S. The operation device comprises an enclosure 111enclosing a rotatable structure 135 comprising a plurality of magnets133 fixated thereto. The magnets are adapted to be affected by a movingmagnetic field created by coils 232 of an external unit 200, such thatthe magnets 133 and thus the rotatable structure 135 moves along withthe moving magnetic field of the external unit 200.

The operation device 110 further comprises a gear system 140 (furtherdisclosed in relation to other embodiments herein, such as withreference to FIGS. 3a, 3b ) comprising operable elements 143′″aconnected to a force input 142 of the gear system, which in turn isconnected to the rotatable structure comprising the magnets 133. By theindirect connection with the rotatable structure 135, the operableelements 143′″a, 143′″b are propelled by the magnets 133 moving alongwith the moving magnetic field of the external unit 200. The gear systemfurther comprises a first gear 144 having the shape of a hollowcylinder, comprising a first number of teeth, on the peripheral outsidethereof, and a second gear 145 having the shape of a hollow cylinder,comprising a greater number of teeth than the first gear 144, on theinside surface thereof. The operable elements 143′″a, 143′″b are adaptedto engage the inside of the first gear 144, such that the outside of thefirst gear 144 is pressed against the inside of the second gear 145 suchthat the teeth of the first gear 144 are interengaged with the teeth ofthe second gear 145 in two positions interspaced by positions in whichthe teeth are not interengaged. The operation of the operable elements143′″a, 143′″b advances the positions and thereby causes relativerotation between the first gear 144 and the second gear 145. The gearsystem further comprises a third gear 146 comprising the same amount ofteeth as the first gear 144 and thus rotates along with the interengagedpositions between the first 144 and second gear 145. The third gear 146is connected to a force output of the gear system by means of a radiallyextending structure 147. The force output 149 may for example bedirectly or indirectly connected to a body engaging portion of theoperable implant or to a threaded member adapted to transform a rotatingforce to a reciprocating force. The threaded member may in turn bedirectly or indirectly connected to a movable wall portion of areservoir for changing the volume of the reservoir (such as furtherdisclosed in relation to other embodiments herein).

The operation device 110 is hermetically enclosed by an enclosure 111.The enclosure could be made from a ceramic material, such as siliconcarbide or zirconium carbide, or a polymer material, such as UHWPE orPTFE, or glass. In any instance the enclosure should be made from amaterial with low permeability, such that migration of bodily fluidsthrough the walls of the enclosure is prevented.

The implantable operation device 110 may additionally comprise awireless communication unit adapted to at least one of: receive wirelesscommunication signals from an external unit, and transmit wirelesscommunication signals to an external unit.

The external unit 200 for supplying force to the implanted operationdevice 110 comprises an external drive 210 unit adapted to create amoving magnetic field on the outside of the patient's skin S adapted toaffect the magnets 133 of the implanted operation device 110, such thatthe magnets 133 moves along with the moving magnetic field of theexternal drive unit 210. The external drive unit comprises a set ofcoils 232 circularly distributed around a rotational axis of theexternal unit 200, such that sequential energizing of the coils createsa rotating magnetic field adapted to affect the magnets 133 of theimplanted operation device 110, such that the magnets 133 moves alongwith the moving magnetic field of the external drive unit 210.

The external unit 200 may additionally comprises a wirelesscommunication unit for receiving wireless communication signals from animplantable unit, and/or transmitting wireless communication signals tothe implantable unit.

FIG. 33 shows an alternative embodiment of the system for transferringenergy from the outside of the body of a patient to an operable implant100 placed inside the body of the patient. In the alternativeembodiment, the device comprises an external unit 200 comprising anexternal drive unit 210. The external drive unit 210 comprises anexternal rotatable structure 235 comprising positive and negativepermanent magnets 233 p, 233 n. The rotatable structure 235 is fixatedto a shaft connected to an electrical motor 230 in the external unit 200for rotating the rotatable structure 235. The magnets 233 p, 233 n ofthe rotatable structure 235 are adapted to magnetically connect toimplanted magnets 133 p, 13311 of a reciprocating structure 428. Theimplanted magnets 133 p has positive polarity and are thus alternatinglyattracted and repelled by the positive and negative magnets 233 p, 233 nconnected to the rotatable structure 235 of the outside of the body ofthe patient. As the rotatable structure 235 rotates, an alternatingmagnetic field is created, causing reciprocation of implanted magnets133 p and thus of the reciprocating structure 428 to which the magnets133 p are connected. The reciprocating structure 428 is in turnconnected, directly or indirectly to a body engaging portion of theoperable implant, such that the reciprocating movement of thereciprocating structure operates the body engaging portion.

FIG. 34 shows an alternative embodiment of the system for transferringenergy from the outside of the body of a patient to an operable implant100 placed inside the body of the patient, similar to the system shownwith reference to FIG. 34. The difference is that the reciprocatingstructure 428 is connected to a hinged connecting rod 422, which in theother end is connected to a flywheel 423. The flywheel 423 is in turnconnected to a gear system 424, in form of a bevel gear for altering thedirection of the force supplied to a first shaft 142, being the forceinput 142 of a hydraulic pump adapted to operate a hydraulicallyoperated body engaging portion 180. The alternating magnetic fieldgenerated by the external unit 200, on the outside of the skin S of thepatient, thus operates the body engaging portion 180 by means of ahydraulic pump 150 and a fluid conduit 162.

FIG. 35a shows a system for transferring rotating force from outside ofthe patients skin S into the body of the patient. The system is adaptedto transfer rotating force with minimal squeezing of the skin S of thepatient. The system comprises an external rotating structure 235′,having a larger diameter than an internal rotating structure 135′. Theexternal rotating structure 235′ comprises magnets 233 arranged on theinside of an external spherical cap 235′ such that the radial forcerotating the internal rotatable structure 135′ is greater than the axialforce exerted by the magnets 233. The axial force exerted by the magnets133, 233 presses the internal rotatable structure 135′ against theexternal rotatable structure 235′ and thus squeezes the skin S of thepatient between the internal and external rotatable structures 135′,235′. The internal magnets 133 are mounted to a rotatable structure 135′in the form of a rotatable internal spherical cap 135′.

FIG. 35b shows an alternative embodiment of the medical system in whichthe both the internal rotating structure 135′ and the external rotatingstructure 235′ comprises repelling magnets 133 c, 233 c placed centrallyon the internal and external spherical caps 135′, 235′. The repellingmagnets 133 c, 233 c are adapted to decrease the axial forces created bythe magnetic connection between the internal and external magnets 133,233, such that the squeezing effect on the patient's skin S is reduced.In the embodiment shown in FIG. 35b , the repelling magnets 133 c, 233 care permanent magnets having a constant magnetic force, however, inalternative embodiments, it is conceivable that the repelling magnets133′, 233′ are electromagnets enabling the magnetic force of therepelling magnets 133 c, 233 c to be adjusted by altering the currentsupplied to the electromagnet. In yet another embodiment, the repellingmagnet of the external rotating structure 235′ could be an axiallymovable permanent magnet, such that the distance between the skin S ofthe patient and the permanent magnet can be adjusted, such that therepelling force (and thus the squeezing force), can be adjusted. Themagnets 133, 233 and repelling magnets 133 c, 233 c could also be usedfor the purpose of aligning the receiving unit and the external unit (ortransmitting unit 220 of the external unit 200) such that the forcetransfer is optimized.

FIG. 35c shows an alternative concept for transferring rotating forcefrom outside the body of the patient to the inside thereof. The conceptincludes using a plurality of satellite permanent magnets 233 and aplurality of permanent magnets 133 placed on a rotatable disc inside thebody of the patient. The plurality of internal and external permanentmagnets 133, 233 comprises positive 133 p, 133 p and negative 133 n, 233n poles. As the external satellite magnets rotate they propel therotating disc by the magnetic connection with the satellite magnets 233as the attracting poles 233 n, 233 p of the satellite magnets alternatesin alignment with the poles of the permanent magnets 133 of therotatable disc.

FIG. 36 shows an embodiment of an operable implant 100 comprising animplantable generator 170 for generating electrical current to theoperable implant 100. The operable implant 100 comprises a receivingunit 120 comprising a plurality or coils 132 circularly distributed on adisc. The coils 132 are in magnetic connection with an external unit 200comprising a rotatable structure 235 comprising magnets 233 fixatedthereto. The rotation of the magnets 233 generates a moving magneticfield which affects the coils 132, such that electrical current isinduced in the coils 132. The receiving unit 120 or generator 170 isconnected to an implantable battery 190 by means of a lead 192. Afurther lead 192′ connects the battery 190 to a control unit 195 adaptedto control a hydraulic pump 150, which for example could be any of thehydraulic pumps disclosed herein. The hydraulic pump 150 is adapted totransfer a hydraulic fluid from the reservoir 160 to a hydraulicallyoperable body engaging portion 180 by means of a fluid conduit 162.

Now turning the external unit 200, the external unit 200 comprises anexternal drive unit 210 comprising an electrical motor 230 which bymeans of a shaft is connected to a rotatable structure 235 to which theexternal magnets 233 are connected.

FIG. 37 shows an alternative embodiment of the implantable generator170, in which the implantable generator 170 is an implantable lineargenerator in which a current is generated in a coil 132 by means of arod-shaped magnet 133 is moved back and forth in the winding of the coil132. The external drive unit 210 of the external unit 200 comprises anexternal rotatable structure 235 comprising positive and negativepermanent magnets 233 p, 233 n. The rotatable structure 235 is fixatedto a shaft connected to an electrical motor 230 in the external unit 200for rotating the rotatable structure 235. The magnets 233 p, 233 n ofthe rotatable structure 235 are adapted to magnetically connect toimplanted magnets 133 p of a reciprocating structure 428. The implantedmagnets 133 p has positive polarity and are thus alternatingly attractedand repelled by the positive and negative magnets 233 p, 233 n connectedto the rotatable structure 235 of the outside of the body of thepatient. As the rotatable structure 235 rotates, an alternating magneticfield is created, causing reciprocation of implanted magnets 133 p andthus of the reciprocating structure 428 to which the magnets 133 p areconnected. The reciprocating structure 428 is in turn connected to therod-shaped magnet 133. The coil 132, in which the current is induced, isconnected to an implantable battery 190 by means of leads 192. A furtherlead 192′ connects the battery 190 to a control unit 195 adapted tocontrol a hydraulic pump 150, which for example could be any of thehydraulic pumps disclosed herein. The hydraulic pump 150 is adapted totransfer a hydraulic fluid from the reservoir 160 to a hydraulicallyoperable body engaging portion 180 by means of a fluid conduit 162.

FIG. 38a-38c schematically shows alternative embodiments fortransferring moving force between the outside of the body of thepatient, and the inside of the body of the patient, for generatingelectrical current inside of the body of a patient by means of anelectrical generator 170. FIG. 38a schematically shows and embodiment inwhich a permanent magnet 233 is located on the outside of the body ofthe patient and magnetically connected to a magnet 133 of an implantablegenerator on the inside of the skin S of the patient. The externalmagnet 233 is adapted to reciprocate and thus creating a reciprocatingmagnetic field affecting the magnet 133 on the inside of the skin S ofthe patient, such that the magnet 133 reciprocates inside of a coil 132such that an electrical current is generated in the coil 132.

FIG. 38b shows an alternative embodiment similar to the embodiment shownin FIG. 38a . The difference being that the internal magnet 133 isspring loaded by means of a spiral spring 492, such that thereciprocating movement of the internal magnet 133 is created by magneticforce from the magnetic connection with the external unit magnet 233 inone direction, and by the action of the spring 492 in the oppositedirection. The external magnet may be adapted to attract the internalmagnet 133 or be adapted to repel the internal magnet 133.

FIG. 38c shows an embodiment of the system for transferring forcesimilar to the system shown in FIG. 38c , the difference being that theexternal magnet 233 e is an electromagnet 233 e adapted to attract theinternal magnet 133. The electromagnet 233 e creates the alternatingmagnetic field by means of altering the electrical current runningthrough the coil of the electromagnet, and thus altering the magneticforce supplied by the electromagnet 233 e. Just as in the embodimentdescribed with reference to FIG. 38b , the internal magnet 133 is springloaded by means of a spiral spring 492.

FIG. 39 shows an embodiment of the operable implant 100 adapted to beimplanted in the body of a patient. The operable implant 100 comprisingan operation device 110, similar to the operation device shown in FIG.32, and a body engaging portion 180. The operation device 110 comprisesa movable part in form of a rotatable structure 135 connected to thebody engaging portion 180 via a hydraulic pump 150. The rotatablestructure 135 comprises a plurality of magnets 133 connected thereto.The magnets 133 are adapted to magnetically connect to a moving magneticfield generated by the external unit 200 on the outside of the patient'sskin S, such that the rotatable structure 135 rotates along with themoving magnetic field. The operation device 110 further comprises animplantable generator 170 connected to the rotatable structure 135 andadapted to transform movement to electrical current, such that themovement of the rotatable structure 135 operates the body engagingportion 180 and generates electrical current.

The implantable generator 170 comprises two coils 132′ and severalmagnets 133 mounded to a shaft being the force input 142′, 142″ of theimplantable generator and the hydraulic pump 150. The movement of themagnets 133′ in relation to the coils 132′ induces an electrical currentin the coils 133′.

The operation device 110 further comprises a battery 190 connected tothe implantable generator 170 by means of leads 192.

In an alternative embodiment, the magnets 133 of the rotatable structure135 may further affect the coils 132′ of the generator 170, such thatthe same magnets may be used for connecting to the external unit 200 andfor generating electrical current in the implantable generator 170.

The operable implant 100 may further comprise a control unit forcontrolling at least one parameter of the operable implant, and thecontrol unit may be connected to the battery 190 such that the batterypowers the control unit.

In the embodiment shown in FIG. 39, the body engaging portion 180 is ahydraulically operable body engaging portion 180 connected to thehydraulic pump 150. The hydraulic pump 150 comprises a reservoir adaptedto hold hydraulic fluid and being connected to the hydraulic pump, suchthat the hydraulic pump can transport hydraulic fluid from the reservoirto the body engaging portion 180. The hydraulic pump 150 may comprise amovable wall portion of the reservoir (such as described in relation toother embodiments herein). The fluid is then transported from thereservoir to the body engaging portion 180 by moving the movable wallportion and thereby changing the volume of the reservoir.

In alternative embodiments, the hydraulic pump could be for example anon-valve pump, a pump comprising at least one valve, a peristalticpump, a membrane pump, a gear pump or a bellows pump.

FIG. 40 shows an alternative embodiment of the operable implant, similarto the embodiment described with reference to FIG. 39. The difference isthat the implantable operation device of FIG. 40 comprises a magnet 132adapted to perform a reciprocating movement in a magnet guide 421. Themagnet 133 is connected to a hinged connecting rod 422, which in theother end is connected to a flywheel 423. The flywheel 423 is in turnconnected to a gear system 424, in form of a bevel gear for altering thedirection of the force supplied to a first shaft, being the force input142′ of the implantable generator 170, and a second shaft, being theforce input 142″ of a mechanically operated body engaging portion 180.The magnet 133 is magnetically connected to a reciprocating magneticfield generated by the external unit 200, on the outside of the skin Sof the patient, such that the structure for reciprocating movement (133,422) moves along with the reciprocating magnetic field. Thereciprocating magnetic field is created by the external unit 200 as analternating magnetic field, i.e. a magnetic field is generated whichalternates in magnetic strength.

FIG. 41 shows an operation device 110 a-100 c of an operable implant 100for implantation in the body of a patient in which the operation deviceis divided into a first and second unit 110 a, 110 b. The first unit 110a comprises a receiving unit 120 for receiving wireless energy, and afirst gear system 140 a adapted to receive mechanical work having afirst force and first velocity, and output mechanical work having adifferent second force and a different second velocity. The receivingunit 120 comprises a coil adapted to transform wireless energy receivedin form of a magnetic field into electrical energy by means of inductiveconnection. The second unit 110 b of the operation device comprises anelectrical motor 130 adapted to transform electrical energy into themechanical work. The electrical motor 130 is a three phase electricalmotor comprising magnetic material, both in form of magnets of the rotorand in the form of iron cores of the coils. The magnetic materialcreates a magnetic field which disturbs other magnetic fields inproximity, such as the magnetic field used for transferring wirelessenergy from a transmitting unit of an external unit to the receivingunit 120 of the operation device 110 a-110 c. For not interfering withthe wireless energy transfer, the first unit 110 a and the distanceelement 110 c is free from metallic and magnetizable components. For thepurpose of reducing the risk that the magnets of the electrical motor130 placed in the second unit 110 a interferes with the magnetic fieldtransferring wireless energy from an external unit to the implantedoperation device, the operation device further comprises a distanceelement 110 c adapted to create a distance between the first and secondunit 110 a, 110 b. The distance could for example be a distance of morethan 1 cm, more than 2 cm, more than 3 cm, more than 4 cm or more than 5cm. The distance element 110 c comprises a lead 122 for transferring theelectrical energy received at the receiving unit 120 of the first unit110 a, to the second unit 110 b, and a mechanical transferring member412 adapted to transfer the mechanical work from the electrical motor130 in the second unit 110 b to the gear system 140 a in the first unit110 a. By means of the distance element 110 c, the first and secondunits 110 a, 110 b are separated such that the receiving unit 120, whenreceiving wireless energy, is not substantially affected by magneticmaterial in the second unit 110 b.

The second unit 110 b additionally comprises a second gear system 140 bplaced in series between the electrical motor 130 and the first gearsystem 140 a. The second gear system 140 b is adapted to receivemechanical work of a first force and velocity from the electrical motor130 and output mechanical work of a different force and velocity. Theforce is transferred from the second gear system 140 b to the first gearsystem 140 a by means of a mechanical transferring member 412, which forexample could be a belt or a rotating shaft. The first and second gearsystems 140 a, 140 b are connected in series such that the first andsecond gear systems 140 a, 140 b, together act as a single gear system.The first and/or second gear systems 140 a, 140 b could for example begear systems according to any of the embodiments shown herein, such asfor example the gear systems described with reference to FIGS. 2a -22.The electrical motor 130 could for example be an alternating current(AC) electrical motor, a direct current (DC) electrical motor, a linearelectrical motor, an axial electrical motor, a piezo-electric motor, athree-phase motor, a more than one-phase motor, a bimetal motor or amemory metal motor. In the embodiment shown in FIG. 41, the second unit110 b furthermore comprises a battery 190 adapted to be connected to thereceiving unit 120 by means of the lead 122, such that the battery 190is charged by the wireless energy received by the receiving unit 120.

The first unit may additionally comprise a communication unit adapted towirelessly communicate with an external unit on the outside of the bodyof the patient.

The first unit 110 a is preferably implanted subcutaneously in theabdominal wall such that the receiving unit 120 can be placed inproximity with a transmitting unit of an external unit transferringwireless energy to the operable implant 100. The operable implant 100may additionally comprise at least one fixation portion for fixating theoperable implant 100 in the body of the patient. The fixation could forexample be performed by fixating the second unit 110 b to fibrosis, afascia and/or a muscular layer towards the inside of the subcutaneousspace of the patient, while allowing the first unit 110 a to restsubcutaneously. Fixating the second unit 110 b to the body of thepatient indirectly fixates the first unit 110 a and reduces the riskthat the first unit 110 a migrates through the skin of the patient. Analternative way of fixating the operation device 110 a-110 c is byplacing the second unit 110 b on the inside of the muscular layers ormuscular fascia of the abdominal wall and placing the distance element110 c through the muscular layers or muscular fascia such that themovement of the operation device is limited in both directions by thefirst and second units 110 a, 110 b being hindered from passing thoughthe hole made in the muscular layers or muscular fascia.

The first gear system 140 a is directly or indirectly connected to abody engaging portion of the operable implant adapted to affect the bodyof the patient in some way, for example by constricting a luminaryorgan. The connection between the operation device and the body engagingportion is further described with reference to other embodiments herein.

The operation device is in the embodiment shown in FIG. 41 enclosed byan enclosure adapted to hermetically enclose the operable implant. Theenclosure could be an enclosure made from a non-metallic material, suchas for example a ceramic material, such as silicon carbide or zirconiumcarbide, or a polymer material, such as UHWPE or PTFE, or glass. In anyinstance the enclosure should be made from a material with lowpermeability, such that migration of bodily fluids through the walls ofthe enclosure is prevented.

The first or second unit may further comprise a control unit forcontrolling at least one parameter of at least one of: the operationdevice, and the body engaging portion. In the embodiment shown in FIG.41, the electrical motor 130 is an alternating current (AC) motor, andthe control unit comprises a frequency converter for altering thefrequency of an alternating current for controlling the alternatingcurrent motor.

The force output of the first gear system 140 a could be indirectlyconnected to the body engaging portion, for example by the first gearsystem 140 a being connected to a hydraulic pump adapted to transfermechanical work into hydraulic power for powering a hydraulicallyoperable body engaging portion. The hydraulic pump could for example bea reservoir acting as a hydraulic pump by means of a wall moving (suchas further described in several embodiments herein), a non-valve pump,at least one valve pump, at least one peristaltic pump, at least onemembrane pump, at least one gear pump, and at least one bellows pump.

The first unit placed subcutaneously may additionally comprise aninjection port for refilling a reservoir or in any way calibrating thefluid level in a hydraulic system of the operable implant, such as thefluid level in the hydraulically operable body engaging portion.

FIG. 42 shows an embodiment of the operation device 110 similar to theembodiment shown with reference to FIG. 42, the main difference beingthat the operation device of the embodiment shown in FIG. 42 comprises aflexible distance element 110 c, such that the first unit 110 a can movein relation to the second unit 110 b. The flexible distance elementcomprises a flexible mechanical force transferring member, which forexample could be a hydraulic tube for transferring hydraulic force, aflexible rotating shaft for transferring rotational force, a wire, abelt, a rod, and a worm gear, or a gear for changing rotational force insubstantially 90 degrees direction. The first unit 110 a of theoperation device 110 shown in FIG. 42 does not comprise a second gearsystem, instead, the mechanical force transferring member 412 is indirect connection with a connecting portion 182, such as a mechanicalforce transferring member or a hydraulic pump, connecting to the bodyengaging portion 180, which in turn connects to the body of the patient,such that the body of the patient can be affected by the operationdevice 110. The flexible distance element is for example made from anelastomeric polymer material, such as silicone or polyurethane.

FIG. 43a shows an embodiment of the operation device 110 similar to theembodiment shown with reference to FIGS. 41 and 42, when fixated to amuscular layer M of the patient. The operation device 110 shown in FIG.43a comprises a first unit 110 a fixated on the inside of a muscularlayer M of the abdominal wall, and a second unit 110 b placedsubcutaneously, i.e. under the skin S of the patient. The first andsecond units 110 a, 110 b of the operation device are connected by meansof a distance element 110 c which pierces the muscular layer M. Thefirst unit 110 a is placed on the inside of the muscular layer M and onthe outside of the muscular layer M limiting elements 402′ arepositioned, hindering the distance elements 110 c from moving in theholes in the muscular layer M, and thus fixates both the first andsecond units 110 a, 110 b. The second unit 110 b comprises the receivingunit 120 for receiving wireless energy and is by means of the distanceelement separated from the rest of the operation device 110 a, such thatmetallic and/or magnetic components of the operation device 110 a doesnot interfere with the wireless energy transfer from the outside thepatient's body to the inside of the patient's body. Fixating the firstunit to the muscular layer M further controls the distance between theskin S and the second unit 110 b, preventing the second unit 110 b frombeing placed so close to the skin S of the patient such that there is arisk that the second unit 110 b migrates through the skin S of thepatient.

FIG. 43b shows an alternative embodiment of the operation device anddistance element 110 c, in which the first unit 110 a of the operationdevice is placed on the outside of the muscular layer M of the abdominalwall. The distance elements 110 c pierces the muscular layer M of theabdominal wall and connected to a limiting element 402″ placed on theinside of the muscular layer M of the abdominal wall. The distanceelements 110 c thus creating a distance between the first unit 110 a ofthe operation device, placed on the outside of the muscular layer M andthe receiving unit 120 placed subcutaneously.

FIGS. 43c and 43d together represents a surgical kit for an enablingadjustment of a distance between the first and second units 110 a, 110 bof the operation device, or between a fixation member of one of theunits and the unit comprising the receiving unit 120. FIG. 43c shows afirst distance element of the surgical kit, made up of two distanceelements. The distance element has a first connecting portion 110 c′adapted to directly or indirectly connect to the at least one part ofthe operation device of the operable implant, and a second connectingportion 110 c″ adapted to directly connect to the unit 110 b comprisingthe receiving unit 120. The first connecting portion 110 c′ acting as afixation member 110 c′ of the operable implant, such that the operationdevice remains fixated to the muscular layer M of the patient. FIG. 43dshows a second part of the surgical kit comprising a second distanceelement having a first connecting portion 110 c′ adapted to directly orindirectly connect to at least one part of the operable implant, and asecond connecting portion 110 c″ adapted to directly or indirectlyconnect to the part of the operation device comprising the receivingmember 120. The second distance element shown in FIG. 43d is adapted tocreate longer distance between the first and second unit 110 a, 110 bthan the first distance element. By having a kit of different distanceelements to choose from, the surgeon can adjust the distance such thatthe receiving unit constantly is positioned subcutaneously, without therisk that the receiving unit migrates through the skin of the patient.

FIG. 43e shows an adjustable distance element 110 c which in one end 110c′ is directly or indirectly connected to a part of the operableimplant, and in the other end 110 c″ is directly or indirectly connectedto the fixation member. The adjustable distance element 110 c is adaptedto adjust the distance between the part of the operable implant and thefixation member, such that the receiving unit can be placedsubcutaneously without the risk of the receiving unit migrating throughthe skin of the patient. The distance element 110 c is adjustable bymeans of the distance element comprising a sleeve being threaded on theinside thereof, in which a threaded shaft 408 is positioned, thethreaded shaft 408 rotating in the threaded sleeve thus extends ofdecreases the length of distance element and thus adjusts the distancebetween the first and second units 110 a, 110 b of the operation device.

The fixation member of the operation device may for example beintegrated with: a control unit, a receiving unit, for receivingwireless energy, a coil, for receiving wireless energy, a receivingunit, for receiving a magnetic field or an electromagnetic field, amagnetic force transferring coupling, an electrical circuit, a pushbutton for controlling any function of the operable implant, an energystorage device, a pushable construction for adjusting the adjustabledistance element, an integrated operation device and receiving unit, forreceiving wireless energy or a magnetic field or an electromagneticfield adapted to generate kinetic energy, a casing for enclosing atleast one of the different parts of the operable implant, or two or morecasings for enclosing at least one of the different parts of theoperable implant in each casing.

The adjustable distance element may be operable from outside the body ofthe patient, such that the distance can be adjusted from outside thebody of the patient. The adjustable distance element could be adjustableelectrically or manually from outside the body of the patient.

The first and/or second end of the adjustable distance element may bedetectable from outside the body of the patient, such that the distancebetween the first and second ends can be determined by means of forexample x-ray or ultrasound.

The distance element 110 c can be made from an elastic and/or flexiblematerial, such that the first end 110 c′ can flex in relation to thesecond end 110 b, which is more comfortable for the patient, especiallywhen the patient moves in a manner affecting the distance element.

The end of the adjustable distance element connected to the receivingunit 120 of the operation device 110 is preferably made from anon-metallic and non-magnetic material, such that the adjustabledistance element does not affect the wireless energy transfer between anexternal unit and the implanted operation device 110.

As the receiving unit 120 receiving wireless energy is positioned in oneend of the adjustable distance element 110, the adjustable distanceelement comprises a lead for transferring electrical current from thereceiving unit 120 to the operation device of the operable implant.

FIG. 44 shows an embodiment of a portion of an operable implant forinjecting a fluid into a portion of the body B of the patient. A portionof an implantable operation device 110 is shown. The portion of theoperation device comprises a threaded member 441 a which is adapted tobe rotated by a connection with a portion of the operation deviceadapted to create rotating force. The threaded member is guided in asleeve 149 a comprising corresponding internal threads, such that therotation of the threaded member advances the threaded member axially.The threaded member is in turn connected to a piston 426, being amovable wall portion of a reservoir 160 adapted to contain a hydraulicfluid. The rotation of the treaded member pushes the piston inside thereservoir, decreasing the volume of the reservoir 160 and thereby movingthe hydraulic fluid through a fluid conduit 162. The operation device110 is by means of the fluid conduit 162 connected to a body engagingportion 180 comprising an outer sleeve 425 in which an inner sleeve 149b is mounted. The inner sleeve 149 b is adapted to be rotated to causeaxial movement of a threaded portion 441 b through which a needle 427 ispositioned. The needle 427 is adapted to be advanced to inject the fluidinto the portion of the body B of the patient. As the needle 427 isadvanced, it penetrates a membrane 417 of the body engaging portion.When the needle 427 is retracted it is protected by the membrane 417,such that the in-growth of fibrotic tissue does not damage the functionof the body engaging portion 180.

The operable implant shown in FIG. 44 could be used to inject amedicament having a therapeutic affect into e.g. blood vessel or muscleof the patient. Alternatively, the operable implant may be used todeliver a fluid to the body B of the patient for its mechanicalproperties, such as a volume filling fluid or lubricating fluid.

The threaded member 441 a of the operation device 110 is may for examplebe connected to any of the electrical motors described herein, with orwithout the use of a gear system, such as any of the gear systemsdisclosed herein. The operable implant may be powered by means of animplantable battery (such as described with reference to otherembodiments herein) or by means of wireless energy supplied from outsidethe body of the patient.

FIG. 45a shows one example of a body engaging portion 180 in which thebody engaging portion 180 is adapted to constrict a luminary organ L,such as a the urethra, of a patient. The body engaging portion 180 is atorus-shaped hydraulically inflatable body engaging portion connected toan operation device 110, such as any of the operation device shownherein, by means of a fluid conduit 162. The body engaging portion 180is elastic or collapsible such that the inflation thereof constricts theluminary organ L. In the case in which the luminary organ L is theurethra, the constricting hydraulically operable body engaging portion180 constricts the urethra and thus stops the flow of urine therein,thus treating incontinence.

FIG. 45b shows an embodiment of the operable implant similar to theembodiment described with reference to FIG. 45a , the difference beingthat the embodiment shown in FIG. 45b comprises a first and secondhydraulically operable body engaging portion 180 a, 180 b, both adaptedto constrict the luminary organ L to stop the flow of fluid therein. Theembodiment shown in FIG. 45b thus allows the luminary organ to beconstricted in two different places and alternate therebetween, suchthat the strain on a specific portion of the luminary organ is reduced.The first and second hydraulically operable body engaging portions 180a, 180 b are each connected to a first and second fluid conduit 162 a,162 b, which may be connected to a first and second hydraulic pump, orto a first and second end of a hydraulic pump, such as to a first andsecond end of a peristaltic hydraulic pump. The operation device 110 maybe programmed such that the operable implant alternates automaticallybetween constricting a first and second portion of the luminary organ Lfor example after a pre-determined time has elapsed.

FIG. 45c shows an alternative embodiment of the operable implant, inwhich the operable implant comprises a body engaging portion adapted tomechanically engage a portion of the body B of the patient. The portionof the body B of the patient could for example be the urethra of thepatient, and the mechanical body engaging portion 180 could for examplebe adapted to lift the urethra to relieve the patient of incontinence.The mechanical body engaging portion 180 could for example be a flexibleband, such as a band made from silicone. The operation device 110connected to the mechanical body engaging portion 180 may be any of themechanical operation devices shown herein, and could preferably comprisean electrical motor and a gear system. The body engaging portion 180could be connected to the mechanical operation device 110 such that theforce output of the gear system engages the body engaging portion 180.

The different aspects or any part of an aspect or different embodimentsor any part of an embodiment may all be combined in any possible way.Any method or any step of method may be seen also as an apparatusdescription, as well as, any apparatus embodiment, aspect or part ofaspect or part of embodiment may be seen as a method description and allmay be combined in any possible way down to the smallest detail. Anydetailed description should be interpreted in its broadest outline as ageneral summary description, and please note that any embodiment or partof embodiment as well as any method or part of method could be combinedin any way. All examples herein should be seen as part of the generaldescription and therefore possible to combine in any way in generalterms.

NUMBERED EMBODIMENTS

In the following, exemplifying numbered embodiments are provided ingroups A AK and numbered within that group. The numbered embodiments arenot to be seen as limiting the scope of the invention, which is definedby the appended claims. The reference numerals in the different numberedembodiments are to be seen only as examples of elements in the appendeddrawings which correspond to elements described in the numberedembodiments.

Numbered Embodiment A 1-36

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, wherein the operation device comprises:        -   a first unit comprising:            -   a receiving unit for receiving wireless energy, and            -   a first gear system adapted to receive mechanical work                having a first force and first velocity, and output                mechanical work having a different second force and a                different second velocity,            -   a second unit comprising an electrical motor adapted to                transform electrical energy to the mechanical work, and        -   a distance element comprising:            -   a lead for transferring the electrical energy from the                first unit to the second unit, and            -   a mechanical transferring member adapted to transfer the                mechanical work from the electrical motor in the second                unit to the gear system in the first unit, wherein        -   the distance element is adapted to separate the first and            second units such that the receiving unit, when receiving            wireless energy, is not substantially affected by the second            unit.    -   2. The operable implant according to embodiment 1, wherein the        receiving unit comprises at least one coil adapted to transform        wireless energy received in form of a magnetic field into        electrical energy.    -   3. The operable implant according to embodiment 2, wherein the        receiving unit comprises at least a first coil having a first        number of windings, and at least a second coil having a second,        different number of windings.    -   4. The operable implant according to any one of the preceding        embodiments, wherein the gear system comprises:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear.    -   5. The operable implant according to embodiment 4, wherein the        operable element comprises at least one of; a planetary gear and        a structure or wheel at least partly using friction to        interconnect with the first gear.    -   6. The operable implant according to any one of the preceding        embodiments, wherein the second unit comprises a second gear        system adapted to receive the mechanical work output from the        first gear system with the different second force and the        different second velocity as input, and output mechanical work        having a third different force and third different velocity, and        wherein the gear system of the second unit is connected in        series with the gear system of the first unit, via the        mechanical transferring member of the distance element.    -   7. The operable implant according to any one of the preceding        embodiments, wherein the first unit comprises a second gear        system adapted receive mechanical work of a first force and        velocity as input, and output mechanical work having a different        force and velocity, and wherein the second gear system is        connected in series with the first gear system.    -   8. The operable implant according to any one of the preceding        embodiments, wherein the first unit is adapted to be placed at        least in one of the following places: subcutaneously,        subcutaneously in the abdominal wall and in the abdomen.    -   9. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor comprises magnetic        material and wherein the first unit is substantially unaffected        by the magnetic material in the second unit, during wirelessly        energy transfer.    -   10. The operable implant according to any one of embodiments        4-9, wherein the first gear system comprises a third gear, and        wherein the inside of the third gear comprises the same amount        of teeth as the outside of the first gear, and wherein teeth of        the third gear are adapted to interengage with the teeth of the        first gear such that the third gear rotates in relation to the        second gear, along with the at least one interengaged position.    -   11. The operable implant according to embodiment 8, wherein the        second unit comprises at least one fixation portion for fixating        the second unit to at least one of: fibrosis, a fascia and a        muscular layer towards the inside of the subcutaneous space of        the patient.    -   12. The operable implant according to any one of the preceding        embodiments, wherein the distance element is adapted to be at        least one of; placed through the muscular layers of the        abdominal wall, and fixated to the muscular fascia facing the        subcutaneous space.    -   13. The operable implant according to any one of the preceding        embodiments, wherein the distance element is flexible such that        the first and second unit can move in relation to each other.    -   14. The operable implant according to any one of the preceding        embodiments, wherein the mechanical transferring member        comprises a mechanical transferring member selected from:        -   a hydraulic tube for transferring hydraulic force        -   a rotating shaft for transferring rotational force        -   a flexible member for transferring rotational force,        -   a wire,        -   a belt,        -   a rod,        -   a worm gear, and        -   a gear for changing rotational force in substantially 90            degrees direction.    -   15. The operable implant according to any one of the preceding        embodiments, further comprising an enclosure adapted to        hermetically enclose the operable implant.    -   16. The operable implant according to any one of the preceding        embodiments, further comprising a metallic enclosure adapted to        enclose at least one of the second unit and the distance        element.    -   17. The operable implant according to embodiment 16, wherein the        metallic enclosure comprises at least one of: a titanium        enclosure, an aluminum enclosure, and a stainless steel        enclosure.    -   18. The operable implant according to any one of the preceding        embodiments, wherein at least one of the first and second units        comprises a battery adapted to store electrical energy received        at the receiving unit.    -   19. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor comprises an        electrical motor selected from:        -   an alternating current (AC) electrical motor,        -   a direct current (DC) electrical motor,        -   a linear electrical motor,        -   an axial electrical motor,        -   a piezo-electric motor,        -   a three-phase motor        -   a more than one-phase motor        -   a bimetal motor, and        -   a memory metal motor.    -   20. The operable implant according to any one of the preceding        embodiments, wherein the implantable system further comprises a        control unit for controlling at least one parameter of at least        one of:        -   the operation device, and        -   the body engaging portion.    -   21. The operable implant according to embodiment 20, wherein the        electrical motor is an alternating current (AC) motor, and the        control unit comprises a frequency converter for altering the        frequency of an alternating current for controlling the        alternating current motor.    -   22. The operable implant according to any one of the preceding        embodiments, wherein the first unit comprises hydraulic pump        adapted to transfer mechanical work into hydraulic power for        powering a hydraulically operable body engaging portion, wherein        the hydraulic pump is connected to the force output of the first        or second gear system.    -   23. The operable implant according to embodiment 22, wherein the        hydraulic pump is a hydraulic pump selected from:        -   at least one reservoir acting as a pump by a wall moving by            the mechanical work,        -   at least one reservoir acting as a pump to move fluid by            changing volume,        -   at least one non-valve pump,        -   at least one valve pump,        -   at least one peristaltic pump,        -   at least one membrane pump,        -   at least one gear pump, and        -   at least one bellows pump.    -   24. The operable implant according to any one of the preceding        embodiments, wherein the first unit comprises a reservoir for        supplying fluid to a hydraulically operable body engaging        portion.    -   25. The operable implant according to any one of the preceding        embodiments, wherein the operable implant comprises a third unit        comprising a second reservoir for supplying fluid to a        hydraulically operable body engaging portion.    -   26. The operable implant according to any one of embodiments 24        and 25, wherein the reservoir is operable and comprises at least        one movable wall portion.    -   27. The operable implant according to embodiment 26, wherein the        reservoir comprises at least one of; at least one bellows shaped        portion, a shape adapted to allow movement although covered with        fibrosis and a plate shaped surface, in all cases enabling        movement of the at least one movable wall portion.    -   28. The operable implant according to any one of embodiments        23-27, wherein the reservoir is in fluid connection with a        hydraulically operable body engaging portion, and wherein the        reservoir is adapted to operate the hydraulically operable body        engaging portion by movement of the at least one movable wall        portion.    -   29. The operable implant according to any one of embodiments        23-28, wherein the reservoir is at least one of circular and        torus shaped.    -   30. The operable implant according to any one of embodiments        23-29, further comprising a threaded member arranged to move the        wall portion of the reservoir.    -   31. The operable implant according to any one of embodiments        22-30, further comprising at least one of: a pressure sensor, a        flow sensor and position sensor arranged in connection with at        least one of the pump and the reservoir for determining at least        one of: the pressure or volume in the reservoir, and the        pressure or flow from the hydraulic pump.    -   32. The operable implant according to any one of the preceding        embodiments, wherein the first unit comprises an injection port        for supplying fluid to at least one of: a/the reservoir, and        a/the hydraulically operable body engaging portion.    -   33. The operable implant according to any one of the preceding        embodiments, wherein at least one of the first unit and the        distance element is free from at least one of: metallic and        magnetizable components.    -   34. The operable implant according to any one of the preceding        embodiments, wherein at least one of the first unit and the        distance element is free from magnetic components.    -   35. The operable implant according to any one of the preceding        embodiments, wherein the first unit comprises a communication        unit adapted to wirelessly communicate with an external unit on        the outside of the body of the patient.    -   36. The operable implant according to any one of the preceding        embodiments, wherein the operable element is adapted to deflect        the first gear, and to maintain the first gear deflected such        that the teeth of the first gear are interengaged with the teeth        of the second gear in at least one of; one position, two        positions, three positions, and four or more positions, wherein        the two, three or four positions are angularly spaced positions        interspaced by positions at which the teeth are not        interengaged.

Numbered Embodiment B 1-46

-   -   1. An operable implant for implantation in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, the operation device comprising:        -   an electrical motor comprising:            -   a set of coils circularly distributed around a                rotational axis of the electrical motor,            -   a set of magnets connected to a rotatable structure at                least partially axially overlapping said coils, such                that sequential energizing of said coils magnetically                propels the magnets and causes the rotatable structure                to rotate around the rotational axis,        -   a gear system comprising:            -   an operable element,            -   a first gear having the shape of a hollow cylinder,                comprising a first number of teeth, on the peripheral                outside thereof, and            -   a second gear having the shape of a hollow cylinder,                comprising a greater number of teeth than the first                gear, on the inside surface thereof,            -   wherein the operable element is adapted to engage the                inside of the first gear, such that the outside of the                first gear is pressed against the inside of the second                gear such that the teeth of the first gear are                interengaged with the teeth of the second gear in at                least one position interspaced by positions at which the                teeth are not interengaged, and wherein the operation of                the operable element advances the positions and thereby                causes relative rotation between the first gear and the                second gear,        -   characterized in that the second gear has a smaller diameter            than the rotatable structure and is at least partially            placed in the same axial plane, such that the rotatable            structure at least partially axially overlaps the second            gear, such that the gear system is at least partially placed            inside of the electrical motor.    -   2. The operable implant according to embodiment 1, wherein the        operable element is adapted to deflect the first gear, and to        maintain the first gear deflected such that the teeth of the        first gear are interengaged with the teeth of the second gear in        at least one of; one position, two positions, three positions,        and four or more positions, wherein the two, three and four        positions are angularly spaced positions interspaced by        positions at which the teeth are not interengaged.    -   3. The operable implant according to embodiment 2, wherein the        operable element is adapted to deflect the first gear, and to        maintain the first gear deflected such that the teeth of the        first gear are interengaged with the teeth of the second gear in        at least two angularly spaced positions interspaced by positions        at which the teeth are not interengaged.    -   4. The operable implant according to any one of embodiments 1-3,        wherein the operable element comprises at least one of; a planet        gear and a structure or wheel at least partly using friction to        interconnect with the first gear.    -   5. The operable implant according to any one of embodiments 1-4,        wherein the operation device further comprises a second gear        system comprising:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, wherein        -   the first gear of the first gear system is directly or            indirectly connected to the operable element of the second            gear system, such that the first gear system is connected in            series with the second gear system, such that the first gear            system receives mechanical work having a first force and            first velocity and outputs mechanical work having a second,            different, force and a second, different, velocity, and the            second gear system receives the output mechanical work from            the first gear system, as input, and outputs mechanical work            with a third different force and third different velocity.    -   6. The operable implant according to embodiment 5, wherein the        first and second gear systems are positioned coaxially, along        the rotational axis of the first and second gear systems.    -   7. The operable implant according to embodiment 6, wherein the        second gear of at least one of; the first and second gear system        has a smaller diameter than the rotatable structure and is at        least partially placed in the same axial plane, such that the        rotatable structure at least partially axially overlaps the        second gear of at least one of; the first and second gear        system, such that at least one of; the first and second gear        system is at least partially placed inside of the electrical        motor.    -   8. The operable implant according to embodiment 5, wherein the        first and second gears of the second gear system have a larger        diameter than the rotatable structure, and are at least        partially placed in the same axial plane, such that the first        and second gears of the second gear system at least partially        axially overlaps the rotatable structure, such that the        electrical motor is at least partially placed inside the second        gear system.    -   9. The operable implant according to any one of embodiments 5-8,        further comprising a radially extending connecting structure        directly or indirectly connecting the first gear of the first        gear system to the operable element of the second gear system,        to transfer force from the first gear system to the second gear        system.    -   10. The operable implant according to any one of embodiments        5-9, wherein the first gear system comprises a third gear, and        wherein the inside of the third gear comprises the same amount        of teeth as the outside of the first gear, and wherein teeth of        the third gear are adapted to interengage with the teeth of the        third gear such that the third gear rotates in relation to the        second gear, along with the angularly spaced positions.    -   11. The operable implant according to any one of embodiments        5-9, wherein the first gear of the first gear system indirectly        connects with the operable element of the second gear system via        the third gear of embodiment 10.    -   12. The operable implant according to any one of the preceding        embodiments, wherein the rotatable structure is placed radially        on the inside of the circularly distributed coils.    -   13. The operable implant according to any one of the preceding        embodiments, wherein the rotatable structure is placed radially        on the outside of the circularly distributed coils.    -   14. The operable implant according to any one of the preceding        embodiments, further comprising a coil enclosure adapted to        enclose the coils, such that the coils remain enclosed during        operation of the operation device.    -   15. The operable implant according to any one of the embodiments        1-14, wherein the first gear of at least one of; the first and        second gear system directly or indirectly connects to a threaded        member adapted to transform the radially rotating force to an        axially reciprocating force.    -   16. The operable implant according to embodiment 15, wherein the        threaded member is directly or indirectly connected to a movable        wall portion of a first reservoir for changing the volume of the        first reservoir.    -   17. The operable implant according to embodiment 16, wherein the        threaded member is directly or indirectly connected to a movable        wall portion of a second reservoir for changing the volume of        the second reservoir.    -   18. The operable implant according to embodiment 17, wherein the        movement of the movable wall portion of the first reservoir by        the threaded member in a first direction causes the first        reservoir to expand and the volume in the reservoir to increase,        and wherein the movement of the movable wall of the second        reservoir by the threaded member in a first direction causes the        second reservoir to contract and the volume in the second        reservoir to decrease.    -   19. The operable implant according to embodiment 18, wherein the        first reservoir is in fluid connection with a first        hydraulically operable body engaging portion, and the second        reservoir is in fluid connection with a second hydraulically        operable body engaging portion, and wherein operation of the        electrical motor in a first direction, via the gear system and        its direct or indirect connection with the threaded member,        causes:        -   transportation of fluid from the first reservoir to the            first hydraulically operable body engaging portion, and        -   transportation of fluid from the second hydraulically            operable body engaging portion to the second reservoir.    -   20. The operable implant according to any one of embodiments        16-19, wherein the reservoir is at least one of: circular and        torus shaped.    -   21. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises a circular        reservoir encircling the operation device, and wherein the        circular reservoir comprises a movable wall portion adapted to        compress and expand the circular reservoir, thereby altering the        volume of the reservoir, and wherein the movable wall portion is        connected to the operation device, such that the operation of        the operation device changes the volume of the circular        reservoir.    -   22. The operable implant according to any one of embodiments        16-21, wherein a portion of the wall of the reservoir comprises        at least one of: a bellows structure, a shape adapted to allow        movement although covered with fibrosis, and a plate shaped        surface, in all cases enabling movement of the at least one        movable wall portion, enabling the compression and/or expansion        of the reservoir.    -   23. The operable implant according to any one of the preceding        embodiments, further comprising a peristaltic pump, wherein the        peristaltic pump comprises a hollow member for fluid        transportation, and an operable compression member adapted to        engage and compress the hollow member, and wherein the first        gear is in direct or indirect connection with the compression        member, such that the operation of the electrical motor operates        the compression member such that fluid is transported in the        hollow member.    -   24. The operable implant according to embodiment 23, wherein the        operable compression member is connected to the third gear of        embodiment 10.    -   25. The operable implant according to any one of embodiment 23        and 24, wherein hollow member of the peristaltic pump forms a        loop or part of a loop adapted to at least partially encircle        the operation device in at least partially the same axial plane,        and wherein the operation device is adapted to propel the        compressing member such that the compression member compresses        the hollow member towards the outer periphery of the loop or        part of loop.    -   26. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises an        alternating current (AC) motor, and the operation device further        comprises a frequency converter for altering the frequency of an        alternating current for controlling the alternating current        motor.    -   27. The operable implant according to any one of the preceding        embodiments, further comprising a separate unit comprising a        receiving unit adapted to receive wireless energy transmitted        from outside the body.    -   28. The operable implant according to embodiment 27, wherein the        receiving unit comprises at least one coil adapted to transform        wireless energy received in form of a magnetic, electric or        electromagnetic field into electrical energy.    -   29. The operable implant according to embodiment 28, wherein the        receiving unit comprises at least a first coil having a first        number of windings, and at least a second coil having a second,        different number of windings.    -   30. The operable implant according to any one of embodiments        27-29, wherein the separate unit is adapted to be placed at        least one of; subcutaneously and subcutaneously in the abdominal        wall.    -   31. The operable implant according to any one of the preceding        embodiments, comprising at least one fixation portion for        fixating at least a part of the operable implant to at least one        of fibrosis, a fascia and a muscular layer towards the inside of        the subcutaneous space of the patient.    -   32. The operable implant according to any one of embodiments        27-31, further comprising a distance element connecting the        operation device and the separate unit, wherein the distance        element comprises an electric lead adapted to transfer        electrical energy between the separate unit and the operation        device.    -   33. The operable implant according to embodiment 32, wherein the        distance element is adapted to be placed through the muscular        layers of the abdominal wall and/or fixated to the muscular        fascia facing the subcutaneous space.    -   34. The operable implant according to any one of embodiments 32        and 33, wherein the distance element is flexible such that the        first and second unit can move in relation to each other.    -   35. The operable implant according to any one of embodiments        27-34, wherein the separate unit comprises a reservoir for        supplying fluid to a hydraulic implant.    -   36. The operable implant according to embodiment 35, wherein the        distance element comprises a fluid conduit for transportation of        fluid from the operation device to separate unit to control the        size of the reservoir, or in the opposite direction.    -   37. The operable implant according to any one of embodiments        32-36, wherein the distance element further comprises a        mechanical transferring member adapted to transfer mechanical        work from the operation device to the separate unit.    -   38. The operable implant according to embodiment 37, wherein the        mechanical transferring member comprises a mechanical        transferring member selected from:        -   a hydraulic tube for transferring hydraulic force,        -   a rotating shaft for transferring rotational force,        -   a flexible member for transferring rotational force,        -   a wire,        -   a belt,        -   a rod,        -   a worm gear, and        -   a gear for changing rotational force in substantially 90            degrees direction.    -   39. The operable implant according to any one of embodiments        27-38, further comprising an enclosure adapted to hermetically        enclose the operation device and the separate unit, such that        the operation device and the separate unit are sealed from        bodily fluids when implanted.    -   40. The operable implant according to any one of embodiments        27-39, wherein at least one of the operation device and the        separate unit comprises a battery adapted to store electrical        energy received at the receiving unit.    -   41. The operable implant according to any one of embodiments        27-40, wherein the separate unit comprises an injection port for        supplying fluid to at least one of: a or the reservoir and the        body engaging portion being hydraulically operable.    -   42. The operable implant according to any one of embodiments        27-41, wherein the separate unit, apart from the energy        receiving unit, is free from at least one of; metallic,        magnetizable and magnetic components.    -   43. The operable implant according to any one of embodiments        27-42, wherein the separate unit further comprises a control        unit for controlling at least one parameter of at least one of:        -   the operation device, and        -   the body engaging portion.    -   44. The operable implant according to any one of embodiments        27-43, wherein the separate unit comprises a communication unit        adapted to wirelessly communicate with an external unit on the        outside of the body of the patient.    -   45. The operable implant according to anyone of the preceding        embodiments, comprising a hydraulic pump selected from:        -   at least one reservoir with a wall moving by the mechanical            work acting as a pump,        -   at least one reservoir changing volume to move fluid acting            as a pump,        -   at least one non-valve pump,        -   at least one valve pump,        -   at least one peristaltic pump,        -   at least one membrane pump,        -   at least one gear pump, and        -   at least one bellows pump.    -   46. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor comprises an        electrical motor selected from:        -   an alternating current (AC) electrical motor,        -   a direct current electrical motor,        -   a linear electrical motor,        -   an axial electrical motor,        -   a piezo-electric motor,        -   a three-phase motor        -   a more than one-phase motor        -   a bimetal motor, and        -   a memory metal motor.

Numbered Embodiment C 1-45

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, wherein the operation device comprises:        -   an axial electrical motor comprising:            -   a set of coils circularly distributed around a                rotational axis of the electrical motor,            -   a set of magnets connected to a radially extending                rotatable structure at least partially radially                overlapping said magnets, such that sequential                energizing of said coils magnetically axially propels                the magnets and causes rotation of the rotatable                structure around the rotational axis,        -   a gear system comprising:            -   an operable element,            -   a first gear having the shape of a hollow cylinder,                comprising a first number of teeth, on the peripheral                outside thereof, and            -   a second gear having the shape of a hollow cylinder,                comprising a greater number of teeth than the first                gear, on the inside surface thereof, wherein the                operable element is adapted to engage the inside of the                first gear, such that the outside of the first gear is                pressed against the inside of the second gear such that                the teeth of the first gear are interengaged with the                teeth of the second gear in at least one position                interspaced by positions at which the teeth are not                interengaged, and wherein the operation of the operable                element advances the positions and thereby causes                relative rotation between the first gear and the second                gear,        -   wherein the gear system and the axial electrical motor are            positioned coaxially, along the rotational axis of            electrical motor.    -   2. The operable implant according to embodiment 1, wherein the        operable element comprises at least one of: a planet gear, and a        structure or wheel at least partly using friction to        interconnect with the first gear.    -   3. The operable implant according to any one of embodiments 1        and 2, wherein the first set of coils circularly distributed        around a rotational axis of the electrical motor are positioned        on a magnetizable core structure, and wherein the radially        extending rotatable structure comprises a rotatable disc,        wherein the magnetizable core structure and the rotatable disc        are positioned coaxially and the rotatable disc is connected to        a driving shaft connected to the operable element.    -   4. The operable implant according to embodiment 3, wherein the        operation device further comprises a second magnetizable core        structure comprising a second sets of coils, wherein the second        magnetizable core structure is coaxially positioned to at least        partly overlap the magnets of the rotatable disc, such that the        first set of coils propels the magnets on the first side        thereof; and the second sets of coils propels the magnets on the        second side thereof    -   5. The operable implant according to embodiment 3, wherein the        peripheral diameter circular configuration of at least one of        the first and second set of coils is smaller than the inner        diameter of the first gear, and wherein at least one of the        first and second set of coils is positioned in the same axial        plane as the first gear, such that the axial electrical motor is        at least partially placed inside of the gear system.    -   6. The operable implant according to embodiment 5, wherein the        rotatable disc is directly connected to the operable element.    -   7. The operable implant according to any one of the preceding        embodiments, further comprising a coil enclosure adapted to        enclose the coils, such that the coils remain enclosed separated        from the magnets during operation of the operation device.    -   8. The operable implant according to any one of the preceding        embodiments, wherein the operable element is adapted to deflect        the first gear, and to maintain the first gear deflected such        that the teeth of the first gear are interengaged with the teeth        of the second gear in one of; one position, two positions, three        positions, and four or more positions, wherein the two, three        and four positions are angularly spaced positions interspaced by        positions at which the teeth are not interengaged.    -   9. The operable implant according to embodiment 8, wherein the        operation device comprises a second gear system comprising:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, wherein        -   the first gear of the first gear system is directly or            indirectly connected to the operable element of the second            gear system, such that the first gear system is connected in            series with the second gear system, such that the first gear            system receives mechanical work having a first force and            first velocity and outputs mechanical work having a second,            different, force and a second, different, velocity, and the            second gear system receives the output mechanical work from            the first gear system, as input, and outputs mechanical work            with a third different force and third different velocity.    -   10. The operable implant according to embodiment 9, wherein the        first and second gear systems are positioned coaxially, along        the rotational axis of the first and second gear systems.    -   11. The operable implant according to embodiment 10, further        comprising a radially extending connecting structure directly or        indirectly connecting the first gear of the first gear system to        the operable element of the second gear system, to transfer        force from the first gear system to the second gear system.    -   12. The operable implant according to any one of embodiments        8-11, wherein the first gear system comprises a third gear, and        wherein the inside of third gear comprises the same amount of        teeth as the outside of the first gear, and wherein teeth of the        third gear are adapted to interengage the teeth of the third        gear such that the third gear rotates in relation to the second        gear, along with the angularly spaced positions.    -   13. The operable implant according to any one of embodiments        9-12, wherein the first gear of the first gear system indirectly        connects with the operable element of the second gear system via        the third gear of embodiment 12.    -   14. The operable implant according to any one embodiments 8-13,        wherein the first gear of the first gear system directly or        indirectly connects to a threaded member adapted to transform        the radially rotating force to an axially reciprocating force.    -   15. The operable implant according to embodiment 14, wherein the        threaded member is directly or indirectly connected to a movable        wall of a reservoir for changing the volume of the reservoir.    -   16. The operable implant according to embodiment 15, wherein the        threaded member is directly or indirectly connected to a movable        wall of a second reservoir for changing the volume of the second        reservoir.    -   17. The operable implant according to embodiment 16, wherein the        movement of the movable wall of the first reservoir by the        threaded member in a first direction causes the first fluid        reservoir to expand and the volume in the first fluid reservoir        to increase, and wherein the movement of the movable wall of the        second reservoir by the threaded member in a first direction        causes the second reservoir to contract and the volume in the        second reservoir to decrease.    -   18. The operable implant according to embodiment 17, wherein the        first reservoir is in fluid connection with a first        hydraulically operable body engaging portion, and the second        reservoir is in fluid connection with a second hydraulically        operable body engaging portion, and wherein operation of the        electrical motor in a first direction, by the via the gear        system and its direct or indirect connection with the threaded        member, causes:        -   transportation of fluid from the first reservoir to the            first hydraulically operable body engaging portion, and        -   transportation of fluid from the second hydraulically            operable body engaging portion to the second reservoir.    -   19. The operable implant according to any one of embodiments        15-18, wherein the reservoir is at least one of circular and        torus shaped.    -   20. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises a circular        reservoir encircling the operation device, and wherein the        circular reservoir comprises a movable wall portion adapted to        compress and expand the circular reservoir, thereby altering the        volume of the reservoir, and wherein the movable wall portion is        connected to the operation device, such that the operation of        the operation device changes the volume of the circular        reservoir.    -   21. The operable implant according to any one of embodiments        16-20, wherein a portion of the wall of the reservoir comprises        at least one of; a bellows structure, a shape adapted to        allowing movement although covered with fibrosis and a plate        shaped surface, in all cases enabling movement of the at least        one movable wall portion, enabling the compression and/or        expansion of the reservoir.    -   22. The operable implant according to any one of the preceding        embodiments, further comprising a peristaltic pump, wherein the        peristaltic pump comprises a hollow member for fluid        transportation, and an operable compression member adapted to        engage and compress the hollow member, and wherein the first        gear is in direct or indirect connection with the compression        member, such that the operation of the electrical machine        operates the compression member such that fluid is transported        in the hollow member.    -   23. The operable implant according to embodiment 22, wherein the        operable compression member is connected to the third gear of        embodiment 12.    -   24. The operable implant according to any one of embodiment 22        and 23, wherein hollow member of the peristaltic pump forms a        loop or part of a loop adapted to at least partially encircle        the operation device in at least partially the same axial plane,        and wherein the operation device is adapted to propel the        compressing member such that the compression member compresses        the hollow member towards the outer periphery of the loop or        part of loop.    -   25. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises an        alternating current (AC) motor, and the operation device further        comprises a frequency converter for altering the frequency of an        alternating current for controlling the alternating current        motor.    -   26. The operable implant according to any one of the preceding        embodiments, further comprising a separate unit comprising a        receiving unit adapted to receive wireless energy transmitted        from outside the body.    -   27. The operable implant according to embodiment 26, wherein the        receiving unit comprises at least one coil adapted to transform        wireless energy received in form of a magnetic, electromagnetic        field into electrical energy.    -   28. The operable implant according to embodiment 27, wherein the        receiving unit comprises at least a first coil having a first        number of windings, and at least a second coil having a second,        different number of windings.    -   29. The operable implant according to any one of embodiments        26-28, wherein the separate unit is adapted to be placed at        least one of; subcutaneously and subcutaneously in the abdominal        wall.    -   30. The operable implant according to any one of the preceding        embodiments, comprising at least one fixation portion for        fixating at least part of the operable implant to at least one        of fibrosis, a fascia and a muscular layer towards the inside of        the subcutaneous space of the patient.    -   31. The operable implant according to any one of embodiments        26-30, further comprising a distance element connecting the        operation device and the separate unit, wherein the distance        element comprises an electric lead adapted to transfer        electrical energy between the separate unit and the operation        device.    -   32. The operable implant according to embodiment 31, wherein the        distance element is adapted to be placed through the muscular        layers of the abdominal wall and/or fixated to the muscular        fascia facing the subcutaneous space.    -   33. The operable implant according to any one of embodiments 31        and 32, wherein the distance element is flexible such that the        first and second unit can move in relation to each other.    -   34. The operable implant according to any one of embodiments        27-34, wherein the separate unit comprises a reservoir for        supplying fluid to a hydraulic implant.    -   35. The operable implant according to embodiment 35, wherein the        distance element comprises a fluid conduit for transportation of        fluid from the operation device to control the size of the        reservoir, or in the opposite direction.    -   36. The operable implant according to any one of embodiments        31-35, wherein the distance element further comprises a        mechanical transferring member adapted to transfer mechanical        work from the operation device to the separate unit.    -   37. The operable implant according to embodiment 36, wherein the        mechanical transferring member comprises a mechanical        transferring member selected from:        -   a hydraulic tube for transferring hydraulic force,        -   a rotating shaft for transferring rotational force,        -   a flexible member for transferring rotational force,        -   a wire,        -   a belt,        -   a rod,        -   a worm gear, and        -   a gear for changing rotational force in substantially 90            degrees direction.    -   38. The operable implant according to any one of embodiments        26-37, further comprising an enclosure adapted to hermetically        enclose the operation device and the separate unit, such that        the operation device and the separate unit are sealed from        bodily fluids when implanted.    -   39. The operable implant according to any one of embodiments        26-38, wherein at least one of the operation device and the        separate unit comprises a battery adapted to store electrical        energy received at the receiving unit.    -   40. The operable implant according to any one of embodiments        26-39, wherein the separate unit comprises an injection port for        supplying fluid to at least one of: a or the reservoir and the        body engaging portion being hydraulically operable.    -   41. The operable implant according to any one of embodiments        26-40, wherein the separate unit, apart from the energy        receiving unit, is free from at least one of; metallic,        magnetizable and magnetic components.    -   42. The operable implant according to any one of embodiments        26-41, wherein the separate unit further comprises a control        unit for controlling at least one parameter of at least one of:        -   the operation device, and        -   the body engaging portion.    -   43. The operable implant according to any one of embodiments        26-42, wherein the separate unit comprises a communication unit        adapted to wirelessly communicate with an external unit on the        outside of the body of the patient.    -   44. The operable implant according to any one of the preceding        embodiments, wherein the coil enclosure comprises a material        selected from:        -   a carbon material        -   a boron material        -   a mixture of material        -   a Peek® material        -   an alloy of material        -   a metallic material,        -   titanium,        -   aluminum,        -   a ceramic material,        -   a polymer material,        -   polyurethane,        -   polyether ether ketone,        -   silicone, and        -   Parylene® coated silicone.    -   45. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises an/the        electrical motor selected from:        -   an alternating current (AC) electrical motor,        -   a direct current electrical motor,        -   a linear electrical motor,        -   an axial electrical motor,        -   a piezo-electric motor,        -   a three-phase motor        -   a more than one-phase motor        -   a bimetal motor, and        -   a memory metal motor.

Numbered Embodiment D 1-47

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, the operation device comprises an        electrical motor comprising a static part comprising a plurality        of coils and a movable part comprising a plurality of magnets,        such that sequential energizing of said coils magnetically        propels the magnets and thus propels the movable part, wherein        the operation device further comprises an enclosure adapted to        hermetically enclose the coils of the static part, such that a        seal is created between the static part and the propelled moving        part with the included magnets, such that the coils of the        static part are sealed from the bodily fluids, when implanted.    -   2. The operable implant according to embodiment 1, wherein the        operation device further comprises a control unit for        controlling at least one of the operation device and the body        engaging portion, wherein the enclosure is adapted to enclose        the coils and the control unit.    -   3. The operable implant according to any one of the preceding        embodiments, wherein the operation device further comprises at        least one electrical circuit adapted to indirectly receive        energy drawn from wireless energy supplied from outside the body        of the patient, wherein the enclosure is adapted to enclose the        coils and the electrical circuit.    -   4. The operable implant according to any one of embodiments 1-3,        comprising a separate wireless energy receiving unit comprising        at least one coil adapted to transform wireless energy received        in form of a magnetic, electric or electromagnetic field into        electrical energy.    -   5. The operable implant according to embodiment 4, further        comprising a distance element adapted to create a distance        between the receiving unit and the electrical motor, such that        the receiving unit remains substantially unaffected by metallic        and/or magnetic parts of the static or movable part of the        electrical motor.    -   6. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is an axial electrical        motor, and wherein:        -   a. the coils are circularly distributed around a rotational            axis of the implantable electrical motor such that the            center axis of the helix of the coils are extending in the            axial direction of the implantable electrical motor,            parallel to the rotational axis, and        -   b. the movable part comprises a radially extending rotor on            which the magnets are circularly distributed around the            rotational axis, the magnets in axial direction facing the            coils, such that the magnets at least partially radially            overlaps said coils, such that sequential energizing of said            coils magnetically axially propels the magnets and causes            rotation of the rotor around the rotational axis of the            electrical motor.    -   7. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is a radial electrical        motor, and wherein:        -   a. the coils are circularly distributed around a rotational            axis of the implantable electrical motor such that the            center axis of the helix of the coils are extending in the            radial direction of the rotational axis of the implantable            electrical motors, substantially perpendicular to the            rotational axis, and        -   b. the movable part comprises an axially extending rotor on            which the magnets are circularly distributed around the            rotational axis, the magnets in radial direction facing the            coils, such that the magnets at least partially axially            overlaps said coils, such that sequential energizing of said            coils magnetically propels the magnets and causes rotation            of the rotor around the rotational axis of the electrical            motor.    -   8. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is a linear electrical        motor, and wherein:        -   a. the coils are linearly distributed along a direction of            movement of the movable part, and        -   b. the movable part comprises linearly distributed magnets            along a direction of movement of the movable part, such that            sequential energizing of the coils magnetically propels the            magnets and causes linear movement of the movable part.    -   9. The operable implant according to any one of embodiments 2-8,        wherein the implantable electrical motor is a alternating        current (AC) electrical motor, and wherein the control unit        comprises a frequency converter for altering the frequency of an        alternating current for controlling the alternating current        electrical motor.    -   10. The operable implant according to any one of embodiments        2-9, wherein the implantable electrical motor further comprises        a second enclosure adapted to enclose the movable part, such        that the movable part is sealed from bodily fluids when        implanted.    -   11. The operable implant according to embodiment 10, wherein the        second enclosure is sealingly connected to the first enclosure,        such that the enclosure wall between the movable part and the        static part is engaged in sealing both the first enclosure and        the second enclosure.    -   12. The operable implant according to any one of the preceding        embodiments, wherein at least one of the first and second        enclosure comprises a material selected from:        -   a. a carbon material        -   b. a boron material        -   c. a mixture of material        -   d. a Peek® material        -   e. an alloy of material        -   f. a metallic material,        -   g. titanium,        -   h. aluminum,        -   i. a ceramic material,        -   j. a polymer material,        -   k. polyurethane,        -   l. polyether ether ketone,        -   m. silicone, and        -   n. Parylene® coated silicone.    -   13. The operable implant according to any one of the preceding        embodiments, wherein the second enclosure is sealingly connected        to the first enclosure, such that both the movable part and a        distance element between the movable part and the static part is        sealed by the second enclosure.    -   14. The operable implant according to any one of the preceding        embodiments, further comprising a gear system adapted receive        mechanical work having a first force and velocity as input, from        the rotating part of the electrical motor, and output mechanical        work having a different force and velocity.    -   15. The operable implant according to embodiment 14, wherein the        gear system comprises:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear.    -   16. The operable implant according to embodiment 15, wherein the        second gear has a smaller diameter and is at least partially        placed in the same axial plane as at least one of the movable        part and the static part, such that at least one of the movable        part and the static part at least partially axially overlaps the        second gear, such that the gear system is at least partially        placed inside of the electrical motor.    -   17. The operable implant according to embodiment 15, wherein the        operable element is adapted to deflect the first gear, and to        maintain the first gear deflected such that the teeth of the        first gear are interengaged with the teeth of the second gear in        at least one of; one position, two positions, three positions,        and four or more positions, wherein the two, three and four        positions are angularly spaced positions interspaced by        positions at which the teeth are not interengaged.    -   18. The operable implant according to embodiment 17, wherein the        operable element is adapted to deflect the first gear, and to        maintain the first gear deflected such that the teeth of the        first gear are interengaged with the teeth of the second gear in        at least two angularly spaced positions interspaced by positions        at which the teeth are not interengaged.    -   19. The operable implant according to any one of embodiments        15-18, wherein the operation device further comprises a second        gear system comprising:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, wherein        -   the first gear of the first gear system is directly or            indirectly connected to the operable element of the second            gear system, such that the first gear system is connected in            series with the second gear system, such that the first gear            system receives mechanical work having a first force and            first velocity and outputs mechanical work having a second,            different, force and a second, different, velocity, and the            second gear system receives the output mechanical work from            the first gear system, as input, and outputs mechanical work            with a third different force and third different velocity.    -   20. The operable implant according to embodiment 19, wherein the        first and second gear systems are positioned coaxially, along        the rotational axis of the first and second gear systems.    -   21. The operable implant according to embodiment 20, wherein the        second gear of at least one of; the first and second gear system        has a smaller diameter than the rotatable structure and is at        least partially placed in the same axial plane, such that the        rotatable structure at least partially axially overlaps the        second gear of at least one of; the first and second gear        system, such that at least one of; the first and second gear        system is at least partially placed inside of the electrical        motor.    -   22. The operable implant according to embodiment 19, wherein the        first and second gears of the second gear system have a larger        diameter than the rotatable structure, and are at least        partially placed in the same axial plane, such that the first        and second gears of the second gear system at least partially        axially overlaps the rotatable structure, such that the        electrical motor is at least partially placed inside the second        gear system.    -   23. The operable implant according to any one of embodiments        16-22, further comprising a radially extending connecting        structure directly or indirectly connecting the first gear of        the first gear system to the operable element of the second gear        system of embodiment 19, to transfer force from the first gear        system to the second gear system.    -   24. The operable implant according to any one of embodiments        19-23, wherein the first gear system comprises a third gear, and        wherein the inside of the third gear comprises the same amount        of teeth as the outside of the first gear, and wherein teeth of        the third gear are adapted to interengage with the teeth of the        third gear such that the third gear rotates in relation to the        second gear, along with the angularly spaced positions.    -   25. The operable implant according to any one of embodiments        19-24, wherein the first gear of the first gear system        indirectly connects with the operable element of the second gear        system via the third gear of embodiment 24.    -   26. The operable implant according to any one of embodiments        16-25, wherein the rotatable structure is placed radially on the        inside of the circularly distributed coils.    -   27. The operable implant according to any one of embodiments        16-25, wherein the rotatable structure is placed radially on the        outside of the circularly distributed coils.    -   28. The operable implant according to any one of the preceding        embodiments, wherein the coils remain enclosed during operation        of the operation device.    -   29. The operable implant according to any one of the embodiments        16-28, wherein the first gear of at least one of; the first and        second gear system directly or indirectly connects to a threaded        member adapted to transform the radially rotating force to an        axially reciprocating force.    -   30. The operable implant according to embodiment 29, wherein the        threaded member is directly or indirectly connected to a movable        wall portion of a reservoir.    -   31. The operable implant according to any one of the preceding        embodiments, comprising at least one fixation portion for        fixating at least a part of the operable implant to at least one        of fibrosis, a fascia and a muscular layer towards the inside of        the subcutaneous space of the patient.    -   32. The operable implant according to any one of the preceding        embodiments, further comprising a separate unit comprising a        receiving unit adapted to receive wireless energy transmitted        from outside the body.    -   33. The operable implant according to any one of the preceding        embodiments, comprising a first reservoir in fluid connection        with the body engaging portion being hydraulically operable, and        wherein the operation device, is adapted to cause:        -   transportation of fluid from the first reservoir to the            hydraulically operable body engaging portion.    -   34. The operable implant according to any one of embodiments        30-33, wherein a portion of the wall of the reservoir comprises        at least one of: a bellows structure, a shape adapted to        allowing movement although covered with fibrosis and a plate        shaped surface, in all cases enabling movement of the at least        one movable wall portion, enabling the compression and/or        expansion of the reservoir.    -   35. The operable implant according to embodiment 33, wherein the        operation device comprises a hydraulic pump for transporting the        fluid from the first reservoir to the hydraulically operable        body engaging portion.    -   36. The operable implant according to embodiment 35, wherein the        hydraulic pump is a hydraulic pump selected from:        -   at least one reservoir with a wall moving by the mechanical            work acting as a pump,        -   at least one reservoir changing volume to move fluid acting            as a pump,        -   at least one non-valve pump,        -   at least one valve pump,        -   at least one peristaltic pump,        -   at least one membrane pump,        -   at least one gear pump, and        -   at least one bellows pump.    -   37. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor comprises an        electrical motor selected from:        -   an alternating current (AC) electrical motor,        -   a direct current electrical motor,        -   a linear electrical motor,        -   an axial electrical motor,        -   a piezo-electric motor,        -   a three-phase motor        -   a more than one-phase motor        -   a bimetal motor, and        -   a memory metal motor.    -   38. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises:        -   a first unit comprising:            -   a receiving unit for receiving wireless energy, and            -   a first gear system adapted to receive mechanical work                having a first force and first velocity, and output                mechanical work having a different second force and a                different second velocity,        -   a second unit comprising an electrical motor adapted to            transform electrical energy into the mechanical work, and        -   a distance element comprising:            -   a lead for transferring the electrical energy from the                first unit to the second unit, and            -   a mechanical transferring member adapted to transfer the                mechanical work from the electrical motor in the second                unit to the gear system in the first unit, wherein        -   the distance element is adapted to separate the first and            second units such that the receiving unit, when receiving            wireless energy, is not substantially affected by the second            unit.    -   39. The operable implant according to embodiment 37, wherein the        second unit comprises a second gear system adapted to receive        the mechanical work output from the first gear system with the        different second force and the different second velocity as        input, and output mechanical work having a third different force        and third different velocity, and wherein the gear system of the        second unit is connected in series with the gear system of the        first unit, via the mechanical transferring member of the        distance element.    -   40. The operable implant according to any one of embodiments        37-39, wherein the first unit comprises a second gear system        adapted receive mechanical work of a first force and velocity as        input, and output mechanical work having a different force and        velocity, and wherein the second gear system is connected in        series with the first gear system.    -   41. The operable implant according to any one of embodiments        37-40, wherein the first unit is adapted to be placed at least        in one of the following places: subcutaneously, subcutaneously        in the abdominal wall and in the abdomen.    -   42. The operable implant according to any one of embodiments        37-41, wherein the motor comprises magnetic material and wherein        the first unit is substantially unaffected or not importantly        affected by the magnetic material in the second unit, during        wirelessly energy transfer.    -   43. The operable implant according to any one of embodiments        37-42, wherein the first unit comprises a reservoir for        supplying fluid to the body engaging portion being hydraulically        operable.    -   44. The operable implant according to any one of embodiments        37-43, wherein the first unit comprises hydraulic pump adapted        to transfer mechanical work into hydraulic power for powering a        hydraulically operable body engaging portion, wherein the        hydraulic pump is connected to the force output of the first or        second gear system.    -   45. The operable implant according to embodiment 6, further        comprises a gear system comprising:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear,        -   wherein the gear system and the axial electrical motor are            positioned coaxially, along the rotational axis of            electrical motor.    -   46. The operable implant according to any one of embodiments        15-45, wherein the operable element comprises at least one of a        planet gear, and a structure or wheel at least partly using        friction to interconnect with the first gear.    -   47. The operable implant according to embodiment 45, wherein the        first set of coils circularly distributed around a rotational        axis of the electrical motor are positioned on a magnetizable        core structure, and wherein the radially extending rotatable        structure comprises a rotatable disc, wherein a surface part of        the magnetizable core structure and the rotatable disc are        positioned coaxially and the rotatable disc is connected to a        driving shaft connected to the operable element.

Numbered Embodiment E 1-37

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, wherein the operation device comprises:        -   a. an electrical motor having a force outlet,        -   b. a gear system connected to the force outlet of the            electrical motor, the gear system comprising:            -   i. an operable element,            -   ii. a first gear having the shape of a hollow cylinder,                comprising a first number of teeth, on the peripheral                outside thereof, and            -   iii. a second gear having the shape of a hollow                cylinder, comprising a greater number of teeth than the                first gear, on the inside surface thereof, wherein the                operable element is adapted to engage the inside of the                first gear, such that the outside of the first gear is                pressed against the inside of the second gear such that                the teeth of the first gear are interengaged with the                teeth of the second gear in at least one position                interspaced by positions at which the teeth are not                interengaged, and wherein the operation of the operable                element advances the positions and thereby causes                relative rotation between the first gear and the second                gear, and        -   c. a gear system force outlet connected to the first gear of            the gear system and adapted for supplying force directly or            indirectly to the body engaging portion, the gear system            force outlet comprises a magnetic force coupling for            magnetically, directly or indirectly, connecting to the body            engaging portion for supplying force, and        -   d. an enclosure for hermetically enclosing the operation            device.    -   2. The operable implant according to embodiment 1, wherein the        magnetic force coupling comprises an inside rotating structure        placed inside the enclosure comprising at least one magnet or a        portion comprising magnetic or magnetizable material, and        wherein the magnet or portion comprising magnetic or        magnetizable material is adapted to rotate to transfer force to        a corresponding rotating structure on the outside of the        hermetic enclosure, for directly or indirectly supplying force        to the body engaging portion through the sealed enclosure.    -   3. The operable implant according to embodiment 2, further        comprising the corresponding rotating structure on the outside        of the hermetic enclosure, for directly or indirectly supplying        force directly or indirectly to the body engaging portion.    -   4. The operable implant according to any one of the preceding        embodiments, further comprising a reservoir for holding a        hydraulic fluid, the reservoir comprising a movable wall portion        adapted to change the volume of the reservoir, wherein the        movable wall portion is directly or indirect connected to the        gear system force outlet, such that operation of the electrical        motor, via the gear system changes the volume of the reservoir.    -   5. The operable implant according to embodiment 2, further        comprising the corresponding rotating structure on the outside        of the hermetic enclosure, wherein the corresponding rotating        structure directly or indirectly connects to a threaded member        adapted to transform the radially rotating force to an axially        reciprocating force.    -   6. The operable implant according to embodiment 5, wherein the        threaded member is directly or indirectly connected to the        movable wall of the reservoir of embodiment 4 for changing the        volume of the reservoir.    -   7. The operable implant according to any one of the preceding        embodiments, further comprising a peristaltic pump, wherein the        peristaltic pump comprises a hollow member for fluid        transportation, and an operable compression member adapted to        engage and compress the hollow member, and wherein the gear        system force outlet via the magnetic coupling connects to the        compression member, such that the operation of the electrical        motor, via the gear system, operates the compression member,        such that fluid is transported in the hollow member.    -   8. The operable implant according to any one of the preceding        embodiments, wherein the operation device further comprises a        control unit for controlling at least one of the operation        device and the body engaging portion, wherein the enclosure is        adapted to enclose the operation device including the control        unit.    -   9. The operable implant according to any one of the preceding        embodiments, wherein the operation device further comprises at        least one receiving unit adapted to receive wireless energy        supplied from outside the body of the patient, wherein the        receiving unit is placed separate from the operation device,        wherein the enclosure is adapted to include both the operation        device, a distance element connecting the operation device and        the receiving unit and the receiving unit.    -   10. The operable implant according to embodiment 9, wherein the        distance element is adapted to create a distance between the        wireless energy receiver and at least one of the electrical        motor and the magnetic coupling, such that the wireless energy        receiver remains substantially unaffected or not importantly        affected by metallic and/or magnetic components of the        electrical motor and the magnetic coupling.    -   11. The operable implant according to any one of embodiments 9        and 10, wherein the receiving unit comprises at least one coil        adapted to transform wireless energy received in form of a        magnetic, electric or electromagnetic field into electrical        energy.    -   12. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is an axial electrical        motor comprising:        -   a. a plurality of coils, circularly distributed around a            rotational axis of the electrical motor such that the center            axis of the helix of the coils are extending in the axial            direction of the electrical motor, parallel to the            rotational axis of the electrical motor, and        -   b. magnets, circularly distributed on a radially extending            rotatable structure, on which the magnets are circularly            distributed around the rotational axis, the magnets in axial            direction facing the coils, such that the magnets at least            partially radially overlaps the coils, such that sequential            energizing of the coils magnetically axially propels the            magnets and causes rotation of the rotatable structure            around the rotational axis of the electrical motor.    -   13. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is a radial electrical        motor, comprising:        -   a. a plurality of coils circularly distributed around a            rotational axis of the implantable electrical motor, such            that the center axis of the helix of the coils are extending            in the radial direction of the implantable electrical motor,            substantially perpendicular to the rotational axis of the            motor, and        -   b. a plurality of magnets, circularly distributed on an            axially extending rotatable structure on which the magnets            are circularly distributed around the rotational axis, the            magnets in radial direction facing the coils, such that the            magnets at least partially axially overlaps the coils, such            that sequential energizing of the coils magnetically propels            the magnets and causes rotation of the rotatable structure            around the rotational axis of the electrical motor.    -   14. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is a linear electrical        motor, and wherein:        -   a. the coils are linearly distributed along a direction of            movement of a movable part of the linear electrical motor,            and        -   b. the movable part comprises linearly distributed magnets            along a direction of movement of the movable part, such that            sequential energizing of the coils magnetically propels the            magnets and causes linear movement of the movable part.    -   15. The operable implant according to any one of embodiments        8-14, wherein the electrical motor is a alternating current (AC)        electrical motor, and wherein the control unit comprises a        frequency converter for altering the frequency of an alternating        current for controlling the alternating current electrical        motor.    -   16. The operable implant according to any one of the preceding        embodiments, wherein the enclosure comprises a material selected        from:        -   a. a carbon material        -   b. a boron material        -   c. a mixture of material        -   d. a Peek® material        -   e. an alloy of material        -   f. a metallic material,        -   g. titanium,        -   h. aluminum,        -   i. a ceramic material,        -   j. a polymer material,        -   k. polyurethane,        -   l. polyether ether ketone,        -   m. silicone, and        -   n. Parylene® coated silicone.    -   17. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprising a hydraulic        pump for transporting hydraulic fluid from a reservoir according        to embodiment 4 to the body engaging portion being hydraulically        operable.    -   18. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor comprises an        electrical motor selected from:        -   an alternating current (AC) electrical motor,        -   a direct current electrical motor,        -   a linear electrical motor,        -   an axial electrical motor,        -   a piezo-electric motor,        -   a three-phase motor        -   a more than one-phase motor        -   a bimetal motor, and        -   a memory metal motor.    -   19. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is adapted to drive a        comprised hydraulic pump selected from:        -   at least one reservoir with a wall moving by the mechanical            work acting as a pump,        -   at least one reservoir changing volume to move fluid acting            as a pump,        -   at least one non-valve pump,        -   at least one valve pump,        -   at least one peristaltic pump,        -   at least one membrane pump,        -   at least one gear pump, and        -   at least one bellows pump.    -   20. The operable implant according to any one of embodiments        1-18 and 20, wherein the electrical motor comprises:        -   a set of coils circularly distributed around a rotational            axis of the electrical motor,        -   a set of magnets connected to a rotatable structure at least            partially axially overlapping said coils, such that            sequential energizing of said coils magnetically propels the            magnets and causes the rotatable structure to rotate around            the rotational axis,        -   wherein the second gear has a smaller diameter than the            rotatable structure and is at least partially placed in the            same axial plane, such that the rotatable structure at least            partially axially overlaps the second gear, such that the            gear system is at least partially placed inside of the            electrical motor.    -   21. The operable implant according to any one of the preceding        embodiments, wherein the operable element is adapted to deflect        the first gear, and to maintain the first gear deflected such        that the teeth of the first gear are interengaged with the teeth        of the second gear in at least one of; one position, two        positions, three positions, and four or more positions, wherein        the two, three and four positions are angularly spaced positions        interspaced by positions at which the teeth are not        interengaged.    -   22. The operable implant according to embodiment 21, wherein the        operable element is adapted to deflect the first gear, and to        maintain the first gear deflected such that the teeth of the        first gear are interengaged with the teeth of the second gear in        at least two angularly spaced positions interspaced by positions        at which the teeth are not interengaged.    -   23. The operable implant according to any one of embodiments        1-22, wherein the operation device further comprises a second        gear system comprising:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, wherein        -   the first gear of the first gear system is directly or            indirectly connected to the operable element of the second            gear system, such that the first gear system is connected in            series with the second gear system, such that the first gear            system receives mechanical work having a first force and            first velocity and outputs mechanical work having a second,            different, force and a second, different, velocity, and the            second gear system receives the output mechanical work from            the first gear system, as input, and outputs mechanical work            with a third different force and third different velocity.    -   24. The operable implant according to embodiment 23, wherein the        first and second gear systems are positioned coaxially, along        the rotational axis of the first and second gear systems.    -   25. The operable implant according to any one of embodiments        20-24, wherein the second gear of at least one of; the first and        second gear system has a smaller diameter than the rotatable        structure of embodiment 20 and is at least partially placed in        the same axial plane, such that the rotatable structure at least        partially axially overlaps the second gear of at least one of;        the first and second gear system, such that at least one of; the        first and second gear system is at least partially placed inside        of the electrical motor.    -   26. The operable implant according to anyone of embodiment        23-25, wherein the first and second gears of the second gear        system have a larger diameter than the rotatable structure        included from embodiment 20, and are at least partially placed        in the same axial plane, such that the first and second gears of        the second gear system at least partially axially overlaps the        rotatable structure, such that the electrical motor is at least        partially placed inside the second gear system.    -   27. The operable implant according to any one of the preceding        embodiments, further comprising a radially extending connecting        structure directly or indirectly connecting the first gear of        the first gear system to the operable element of the second gear        system of embodiment 23, for transferring force from the first        gear system to the second gear system.    -   28. The operable implant according to any one of embodiments        1-22, wherein the first gear system comprises a third gear, and        wherein the inside of the third gear comprises the same amount        of teeth as the outside of the first gear, and wherein teeth of        the third gear are adapted to interengage with the teeth of the        first gear such that the third gear rotates in relation to the        second gear, along with the angularly spaced positions.    -   29. The operable implant according to any one of embodiments        1-28, wherein the first gear of the first gear system indirectly        connects with the operable element of the second gear system of        embodiment 23 via the third gear of embodiment 28.    -   30. The operable implant according to any one of embodiments        20-25, wherein the rotatable structure of embodiment 20 is        placed radially on the inside of the circularly distributed        coils.    -   31. The operable implant according to any one of embodiments        20-25, wherein the rotatable structure of embodiment 20 is        placed radially on the outside of the circularly distributed        coils.    -   32. The operable implant according to any one of the preceding        embodiments, wherein the coils remain enclosed during operation        of the operation device.    -   33. The operable implant according to any one of the embodiments        20-32, wherein the first gear of at least one of; the first and        second gear system directly or indirectly connects to a threaded        member adapted to transform the radially rotating force to an        axially reciprocating force.    -   34. The operable implant according to embodiment 33, wherein the        threaded member is directly or indirectly connected to a movable        wall portion of the reservoir according to embodiment 4.    -   35. The operable implant according to any one of the preceding        embodiments, comprising at least one fixation portion for        fixating at least a part of the operable implant to at least one        of fibrosis, a fascia and a muscular layer towards the inside of        the subcutaneous space of the patient.    -   36. The operable implant according to any one of the preceding        embodiments, wherein the first reservoir of embodiment 4 is in        fluid connection with the body engaging portion being        hydraulically operable, and wherein the operation device, is        adapted to cause:        -   transportation of fluid from the first reservoir to the            hydraulically operable body engaging portion.    -   37. The operable implant according to embodiment 36, wherein a        portion of the wall of the reservoir comprises at least one of:        a bellows structure, a shape adapted to allowing movement        although covered with fibrosis and a plate shaped surface, in        all cases enabling movement of the at least one movable wall        portion, enabling the compression and/or expansion of the        reservoir.

Numbered Embodiment F 1-27

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, wherein the operation device comprises:        -   a. an electrical motor having a force output, and        -   b. a start resistance delay member positioned between the            force output of the electrical motor and the body engaging            portion, wherein the start resistance delay member is            adapted to enable the electrical motor to operate with at            least one of; less force or less friction induced by the            direct or indirect connection with the body engaging portion            for a time period, such that the electrical motor can start            with less resistance.    -   2. The operable implant according to any one of the preceding        embodiments, wherein the force output of the electrical motor is        directly or indirectly connected to a force input of a gear        system, the gear system comprising:        -   a. an operable element,        -   b. a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   c. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, and            wherein the gear system comprises a force output connected            to the first gear.    -   3. The operable implant according to any one of the preceding        embodiments, further comprising a second gear system positioned        between the first gear system and the start resistance delay,        the second gear system comprising:        -   a. a force input connected to an operable element, directly            or indirectly connected to the force output of the first            gear system,        -   b. a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   c. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, and            wherein the second gear system comprises a force output            connected to the first gear of the second gear system.    -   4. The operable implant according to any one of the preceding        embodiments, wherein the start resistance delay member is        positioned between the force output of the electrical motor and        the force input of the gear system.    -   5. The operable implant according to any one of embodiments 1-3,        wherein the start resistance delay member is positioned between        the force output of the gear system and the body engaging        portion.    -   6. The operable implant according to embodiment 3, wherein the        start resistance delay member is positioned one of:        -   a. between the force output of the first gear system and the            force input of the second gear systems, and        -   b. between the force output of the second gear system and            the body engaging portion.    -   7. The operable implant according to any one of the preceding        embodiments, wherein the start resistance delay member comprises        a spring.    -   8. The operable implant according to embodiment 7, wherein the        spring is at least one of: a helical spring and a leaf spring.    -   9. The operable implant according to any one of the preceding        embodiments, wherein the start resistance delay member comprise        a mechanical play.    -   10. The operable implant according to embodiment 9, wherein the        mechanical play is one of: a radial mechanical play and a linear        mechanical play.    -   11. The operable implant according to embodiment 10, wherein the        start resistance delay member comprises a radial mechanical play        enabling the force output of the electrical motor to perform at        least one of: 1/10 of a revolution, ⅛ of a revolution, ⅙ of a        revolution, ¼ of a revolution, ½ of a revolution and 1        revolution, before the force output directly or indirectly        engages the driving member.    -   12. The operable implant according to any one of embodiments        2-11, wherein the start resistance delay member is positioned        between one of:        -   a. the force output of the first gear system, and the force            input of the second gear system, and        -   b. the force output of the second gear system, and the body            engaging portion,        -   wherein the start resistance delay comprises a radial            mechanical play enabling the force output of the gear system            to perform at least one of: 1/10 of a revolution, ⅛ of a            revolution, ⅙ of a revolution, ¼ of a revolution, ½ of a            revolution and 1 revolution, before the force output engages            the driving member, such that the force output of the            electrical motor can perform at least one of 1/10 of a            revolution*the transmission of the gear system, ⅛ of a            revolution*the transmission of the gear system, ⅙ of a            revolution*the transmission of the gear system, ¼ of a            revolution*the transmission of the gear system, ½ of a            revolution*the transmission of the gear system and 1            revolution*the transmission of the gear system.    -   13. The operable implant according to any one of the preceding        embodiments, wherein the start resistance delay device comprises        a friction clutch.    -   14. The operable implant according to any one of the preceding        embodiments, wherein the start resistance delay device comprises        at least one element adapted to be operated by centrifugal        force, wherein the at least one element is connected to the        electrical motor and adapted to engage direct or indirect the        body engaging portion when the centrifugal force exerted on the        element exceeds a centrifugal delay force.    -   15. The operable implant according to embodiment 14, wherein the        operable element of the first and/or second gear system        comprises the element adapted to be operated by centrifugal        force, such that the operable element of the gear system engages        the first gear when the centrifugal force exerted on the element        exceeds the centrifugal delay force.    -   16. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is an electrical motor        selected from:        -   an alternating current (AC) electrical motor,        -   a direct current electrical motor,        -   a linear electrical motor,        -   an axial electrical motor,        -   a piezo-electric motor,        -   a three-phase motor        -   a more than one-phase motor        -   a bimetal motor, and        -   a memory metal motor.    -   17. The operable implant according to any one of the preceding        embodiments, wherein the body engaging portion is a        hydraulically operable body engaging portion connected to a        hydraulic pump for transporting hydraulic fluid for operating        the hydraulically operable body engaging portion.    -   18. The operable implant according to embodiment 17, wherein the        hydraulic pump comprises a reservoir comprising at least one        movable wall portion, and wherein the at least one movable wall        portion is in direct or indirect connection with the electrical        motor, such that the electrical motor is arranged to operate the        movable wall portion for changing the volume of the reservoir.    -   19. The operable implant according to any one of the preceding        embodiments, wherein the force output of the electrical motor,        directly or indirectly, connects to a threaded member adapted to        transform a radially rotating force of the electrical motor to        an axially reciprocating force.    -   20. The operable implant according to embodiment 19, wherein the        threaded member is directly or indirectly connected to the        movable wall portion of the reservoir of embodiment 17, for        changing the volume of the reservoir.    -   21. The operable implant according to embodiment 20, wherein the        threaded member is directly or indirectly connected to a movable        wall portion of a second reservoir for changing the volume of        the second reservoir.    -   22. The operable implant according to embodiment 21, wherein the        movement of the movable wall portion of the first reservoir by        the threaded member in a first direction causes the first fluid        reservoir to expand and the volume in the first reservoir to        increase, and wherein the movement of the movable wall portion        of the second reservoir by the threaded member in a first        direction causes the second reservoir to contract and the volume        in the second reservoir to decrease.    -   23. The operable implant according to embodiment 22, wherein the        first reservoir is in fluid connection with a first        hydraulically operable body engaging portion, and wherein the        second reservoir is in fluid connection with a second        hydraulically operable body engaging portion, and wherein        operation of the electrical motor in a first direction, by the        connection with the threaded member, causes:        -   a. transportation of fluid from the first reservoir to the            first hydraulically operable implant, and        -   b. transportation of fluid from the second hydraulic            operable body engaging portion to the second fluid            reservoir.    -   24. The operable implant according to any one of embodiments        18-23, wherein the reservoir is at least one of circular and        torus shaped.    -   25. The operable implant according to any one of the preceding        embodiments, wherein the operable implant comprises a circular        reservoir encircling the operation device, and wherein the        circular reservoir comprises a movable wall portion adapted to        compress and expand the circular reservoir, thereby altering the        volume of the reservoir, and wherein the movable wall portion is        connected to the electrical motor, such that the operation of        the electrical motor changes the volume of the circular        reservoir.    -   26. The operable implant according to any one of embodiments        18-25, wherein a portion of the wall of the reservoir comprises        at least one of; a bellows structure, a shape adapted to        allowing movement although covered with fibrosis and a plate        shaped surface, in all cases enabling movement of the at least        one movable wall portion, enabling the compression and/or        expansion of the reservoir.    -   27. The operable implant according to embodiment 17, wherein the        hydraulic pump comprises a peristaltic pump comprising:        -   a. a hollow member for fluid transportation, and        -   b. an operable compression member adapted to engage and            compress the hollow member, and wherein the electrical motor            is in direct or indirect connection with the compression            member, such that the operation of the electrical machine            operates the compression member such that fluid is            transported in the hollow member.

Numbered Embodiment G 1-21

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, wherein the operation device comprises:        -   a. a first gear system comprising:            -   i. an operable element,            -   ii. a first gear having the shape of a hollow cylinder,                comprising a first number of teeth, on the peripheral                outside thereof, and            -   iii. a second gear having the shape of a hollow                cylinder, comprising a greater number of teeth than the                first gear, on the inside surface thereof, wherein the                operable element is adapted to engage the inside of the                first gear, such that the outside of the first gear is                pressed against the inside of the second gear such that                the teeth of the first gear are interengaged with the                teeth of the second gear in at least one position                interspaced by positions at which the teeth are not                interengaged, and wherein the operation of the operable                element advances the positions and thereby causes                relative rotation between the first gear and the second                gear, and        -   b. a second gear system comprising:            -   i. an operable element,            -   ii. a first gear having the shape of a hollow cylinder,                comprising a first number of teeth, on the peripheral                outside thereof, and            -   iii. a second gear having the shape of a hollow                cylinder, comprising a greater number of teeth than the                first gear, on the inside surface thereof, wherein the                operable element is adapted to engage the inside of the                first gear, such that the outside of the first gear is                pressed against the inside of the second gear such that                the teeth of the first gear are interengaged with the                teeth of the second gear in at least one position                interspaced by positions at which the teeth are not                interengaged, and wherein the operation of the operable                element advances the at least one position and thereby                causes relative rotation between the first gear and the                second gear, wherein        -   c. the first gear of the first gear system is directly or            indirectly connected to the operable element of the second            gear system, such that the first and second gear systems            functions as a single gear system.    -   2. The operable implant according to embodiment 1, wherein the        first gear of the first and second gear system comprises a        deflectable wall, and wherein the operable element is adapted to        deflect the first gear, and to maintain the first gear deflected        such that the teeth of the first gear are interengaged with the        teeth of the second gear in at least one angularly spaced        positions interspaced by positions in which the teeth are not        interengaged, and wherein the operation of the pressing element        rotatively advances the angularly spaced positions and thereby        cause relative rotation between the first gear and the second        gear.    -   3. The operable implant according to embodiment 2, wherein the        operable element is adapted to deflect the first gear, and to        maintain the first gear deflected such that the teeth of the        first gear are interengaged with the teeth of the second gear in        at least one of; at least two angularly spaced positions and at        least three angularly spaced positions, interspaced by positions        at which the teeth are not interengaged.    -   4. The operable implant according to any one of embodiments 1-3,        wherein at least one of the first and second gear systems        comprises a third gear having the shape of a hollow cylinder,        and wherein the inside of third gear comprises the same amount        of teeth as the outside of the first gear, and wherein teeth of        the third gear are adapted to interengage the teeth of the first        gear such that the third gear rotates in relation to the second        gear, along with the at least one interengaged position.    -   5. The operable implant according to embodiment 4, wherein the        first gear system comprises a third gear having the shape of a        hollow cylinder, and wherein the inside of third gear comprises        the same amount of teeth as the outside of the first gear of the        first gear system, and wherein teeth of the third gear are        adapted to interengage the teeth of the first gear such that the        third gear rotates in relation to the second gear, along with        the at least one interengaged position, and wherein the operable        element of the second gear system is connected directly or        indirectly to the third gear of the first gear system.    -   6. The operable implant according to any one of the preceding        embodiments, wherein the first gear system at least partially is        positioned radially inside of the second gear system, such that        the second gear system axially at least partially overlaps the        first gear system.    -   7. The operable implant according to any one of the preceding        embodiments, wherein the first and second gear systems are        positioned coaxially, along the rotational axis of the first and        second gear systems.    -   8. The operable implant according to any one of the preceding        embodiments, further comprising a radially extending connecting        structure directly or indirectly connecting the first gear of        the first gear system with the operable element of the second        gear system, to transfer force from the first gear system to the        second gear system.    -   9. The operable implant according to any one of the preceding        embodiments, further comprising an enclosure, adapted to        hermetically enclose the first and second gear systems, such        that the first and second gear systems are sealed from bodily        fluids when implanted.    -   10. The operable implant according to any one of the preceding        embodiments, wherein the operable element of at least one of the        first and second gear systems comprises at least one of; a        planet gear and a structure or wheel comprising a frictional        surface connection.    -   11. The operable implant according to any one of the preceding        embodiments, further comprising an electrical motor.    -   12. The operable implant according to embodiment 11, wherein the        electrical motor comprises an electrical motor selected from:        -   an alternating current (AC) electrical motor,        -   a direct current electrical motor,        -   a linear electrical motor,        -   an axial electrical motor,        -   a piezo-electric motor,        -   a three-phase motor,        -   a more than one-phase motor,        -   a bimetal motor, and        -   a memory metal motor.    -   13. The operable implant according to any one of embodiments 11        and 12, further comprising an enclosure adapted to hermetically        enclose the first gear system and the electrical motor.    -   14. The operable implant according to embodiment 13, further        comprising a sealed outlet for rotational force, such that the        force can be transferred from the hermetically enclosed first        gear system to the second gear system.    -   15. The operable implant according to any one of embodiments 11        and 12, further comprising a system enclosure adapted to        hermetically enclose the first gear system, the second gear        system and the electrical motor.    -   16. The operable implant according to embodiment 15, further        comprising a sealed outlet for rotational force, such that the        force can be transferred from the hermetically enclosed second        gear system to an operable implant.    -   17. The operable implant according to any one of embodiments 11        and 12, further comprising an enclosure adapted to hermetically        enclose the electrical motor.    -   18. The operable implant according to embodiment 17, further        comprising a sealed outlet for rotational force, such that the        force can be transferred from the hermetically enclosed motor to        the first gear system.    -   19. The operable implant according to any one of embodiments 11        and 12, further comprising an enclosure adapted to hermetically        enclose the static part of the electrical motor, comprising at        least one of; at least two coils and at least one core.    -   20. The operable implant according to embodiment 19, the        enclosure of the static part of the motor, comprising a wall,        the operable implant adapted to create rotational force from the        hermetically enclosed static part wirelessly through the sealed        wall, to create rotational force for rotating a rotor part of        the motor, comprising at least one of; at least one magnet,        magnetizable material and at least one coil, the rotor adapted        to directly or indirectly be further connected to the first gear        system.    -   21. The operable implant according to embodiment 20, further        comprising an enclosure adapted to hermetically enclose the        rotor part of the electrical motor and at least one of; the        first gear system and the first and second gear system.

Numbered Embodiment H 1-21

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, wherein the operation device comprises:        -   a. at least one of; at least one magnet, at least one            magnetic material and at least one magnetizable material            adapted to be affected by a moving magnetic field created by            an external unit, when implanted, such that the magnet or            magnetic or magnetizable material moves along with the            moving magnetic field of the external unit, and        -   b. a gear system comprising:            -   i. an operable element directly or indirectly connected                to the at least one magnet, magnetic material, or                magnetizable material, such that the operable element is                propelled by the magnet or magnetic material moving                along with the moving magnetic field of the external                unit,            -   ii. a first gear having the shape of a hollow cylinder,                comprising a first number of teeth, on the peripheral                outside thereof, and            -   iii. a second gear having the shape of a hollow                cylinder, comprising a greater number of teeth than the                first gear, on the inside surface thereof, wherein the                operable element is adapted to engage the inside of the                first gear, such that the outside of the first gear is                pressed against the inside of the second gear such that                the teeth of the first gear are interengaged with the                teeth of the second gear in at least one position                interspaced by positions in which the teeth are not                interengaged, and wherein the operation of the operable                element advances the positions and thereby causes                relative rotation between the first gear and the second                gear.    -   2. The operable implant according to embodiment 1, wherein the        operation device is adapted to be implanted subcutaneously.    -   3. The operable implant according to embodiment 2, wherein the        operation device is adapted to be implanted subcutaneously in        the abdominal region.    -   4. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises a first unit        and a second unit, and wherein the at least one magnet, magnetic        material, or magnetizable material is placed in the first unit,        and the gear system is placed in the second unit.    -   5. The operable implant according to embodiment 4, further        comprising a distance element adapted to create a distance        between the first and second units.    -   6. The operable implant according to embodiment any one of the        embodiments 4 and 5, wherein the distance element is adapted to        be at least one of; placed through the muscular layers of the        abdominal wall, and fixated to the muscular fascia at the inner        side of the subcutaneous space.    -   7. The operable implant according to any one of embodiments 5        and 6, wherein the distance element is flexible such that the        first and second units can move in relation to each other.    -   8. The operable implant according to any one of embodiments 5-7,        wherein the distance element is adapted to be fixated to at        least one of; the fascia and muscular layer of the abdominal        wall, such that the distance between the first portion of the        operation device and the skin of the patient can be controlled.    -   9. The operable implant according to any one of embodiments 5-8,        wherein the distance element comprises a mechanical transferring        member adapted to transfer force from the first unit to the        second unit, such that force can be transferred from the at        least one magnet, magnetic material, or magnetizable material to        the operable element of the gear system.    -   10. The operable implant according to any one of the preceding        embodiments, further comprising an enclosure adapted to        hermetically enclose at least one of; the operable implant, the        operation device, the body engaging portion, the first unit        according to embodiment 4, the second unit according to        embodiment 4 and the distance element according to embodiment 5,        for sealing from the bodily fluids of the patient.    -   11. The operable implant according to embodiment 10, wherein the        enclosure constitutes a reservoir for supplying fluid to a        hydraulically operable body engaging portion, such that the at        least one magnet, magnetic material, or magnetizable material        and gear system is placed inside of the reservoir.    -   12. The operable implant according to any one of embodiments        1-10, further comprising a reservoir comprising a movable wall        portion adapted to change the volume of the reservoir, wherein        the movable wall portion is directly or indirectly connected to        the first gear of the gear system, such that operation of the        gear system changes the volume of the reservoir.    -   13. The operable implant according to any one of the preceding        embodiments, wherein the first gear of the gear system is        directly or indirectly connected to a threaded member adapted to        transform a rotating force to a reciprocating force.    -   14. The operable implant according to embodiment 13, wherein the        threaded member is directly or indirectly connected to the        movable wall portion of the reservoir of embodiment 12 for        changing the volume of the reservoir.    -   15. The operable implant according to any one of the preceding        embodiments, further comprising a peristaltic pump, wherein the        peristaltic pump comprises a hollow member for fluid        transportation, and an operable compression member adapted to        engage and compress the hollow member, and wherein first gear of        the gear system is in direct or indirect connection with the        compression member, such that the operation of the gear system        operates the compression member such that fluid is transported        in the hollow member.    -   16. The operable implant according to any one of the preceding        embodiments, further comprising a second gear system comprising:        -   a. an operable element,        -   b. a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   c. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the at least one position and thereby            causes relative rotation between the first gear and the            second gear, wherein the first gear of the first gear system            is connected, directly or indirectly to the operable element            of the second gear system, such that the first and second            gear systems functions as a single gear system.    -   17. The operable implant according to any one of the preceding        embodiments, wherein the operable element of at least one of the        first and second gear systems comprises at least one of; a        planet gear and a structure or wheel at least partly using        friction to enable rotating force to be transported.    -   18. The operable implant according to any one of the preceding        embodiments, further comprising a wireless communication unit        adapted to at least one of:        -   a. receive wireless communication signals from an external            unit, and        -   b. transmit wireless communication signals to an external            unit.    -   19. An external unit for supplying force to an implanted        operation device, the external unit comprises:        -   a. an external drive unit adapted to create a moving            magnetic field on the outside of the patient's skin adapted            to affect at least one magnet or magnetic material or            magnetizable material of an implanted operation device, such            that the magnet or magnetic material moves along with the            moving magnetic field of the external drive unit.    -   20. The external unit for supplying force to an operable implant        according to embodiment 19, wherein the external drive unit        comprises a set of coils circularly distributed around a        rotational axis of the external unit, such that sequential        energizing of the coils creates a rotating magnetic field        adapted to affect the magnet or magnetic material or        magnetizable material of the implanted operation device, such        that the magnet or magnetic material moves along with the moving        magnetic field of the external drive unit.    -   21. The external unit for supplying force to an operable implant        according to embodiment 19, wherein the external drive unit        comprises a rotatable structure comprising at least one magnet        or magnetic material, and wherein rotation of the rotatable        structure affects the magnet or magnetic material or        magnetizable material of the implanted operation device causing        rotation thereof, such that the magnet or magnetic material or        magnetizable material rotates along with the rotatable structure        of the external unit.    -   22. The external unit for supplying force to an operable implant        according to any one of embodiments 19-21, further comprising a        wireless communication unit adapted to at least one of:        -   a. receive wireless communication signals from an            implantable unit, and        -   b. transmit wireless communication signals to an implantable            unit.    -   23. A medical system comprising:        -   a. an operable implant according to any one of embodiments            1-18, and        -   b. an external unit according to any one of embodiments            19-22.    -   24. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises a rotatable        structure adapted to hold at least one of; at least one magnet,        at least one magnetic material and at least one magnetizable        material, and further adapted to be affected by the moving        externally created magnetic field, such that the rotatable        structure rotates.    -   25. The operable implant according to any one of the preceding        embodiments, further comprising an enclosure adapted to        hermetically enclose at least one of; the rotational structure        according to embodiment 24, the reservoir according to        embodiment 12, and the treaded member according to embodiment        13, for sealing from the bodily fluids of the patient.    -   26. The operable implant according to any one of embodiments        11-25, wherein the reservoir comprises a wall portion of at        least one of; the enclosure according to embodiment 25 and the        enclosure according to embodiment 10.    -   27. The operable implant according to any one of the preceding        embodiments, comprising a reservoir adapted to contain a        hydraulic fluid and at least one movable wall portion for        changing the volume of the reservoir, wherein the operation        device is adapted to operate the movable wall of the reservoir,        wherein the operation device comprises a gear system placed        within the reservoir, the gear system comprising:        -   i. an operable element,        -   ii. a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   iii. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear.

Numbered Embodiment I 1-24

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising a hydraulic operation        device for supplying hydraulic force and a body engaging portion        adapted to receive the hydraulic force, the hydraulic operation        device comprising:        -   a. a reservoir adapted to contain a hydraulic fluid, the            reservoir comprising at least one movable wall portion for            changing the volume of the reservoir, and        -   b. an operation device adapted to operate the movable wall,            wherein the operation device comprises a gear system placed            within the reservoir, the gear system comprising:            -   i. an operable element,            -   ii. a first gear having the shape of a hollow cylinder,                comprising a first number of teeth, on the peripheral                outside thereof, and            -   iii. a second gear having the shape of a hollow                cylinder, comprising a greater number of teeth than the                first gear, on the inside surface thereof, wherein the                operable element is adapted to engage the inside of the                first gear, such that the outside of the first gear is                pressed against the inside of the second gear such that                the teeth of the first gear are interengaged with the                teeth of the second gear in at least one position                interspaced by positions at which the teeth are not                interengaged, and wherein the operation of the operable                element advances the positions and thereby causes                relative rotation between the first gear and the second                gear.    -   2. The operable implant according to embodiment 1, wherein the        first gear directly or indirectly connects to a threaded member        adapted to transform a rotating force to a reciprocating force.    -   3. The operable implant according to embodiment 2, wherein the        threaded member is directly or indirectly connected to the        movable wall portion of the reservoir such that operation of the        operation device changes the volume of the reservoir.    -   4. The operable implant according to any one of the preceding        embodiments, further comprising a rotatable structure positioned        on the inside of the reservoir and connected to the operable        element of the gear system, the rotatable structure comprising        at least one magnet, at least one magnetic material or at least        one magnetizable material adapted to be in magnetic connection        with a rotating magnetic field outside of the reservoir, such        that the rotating magnetic field on the outside of the reservoir        propels the rotatable structure inside of the reservoir.    -   5. The operable implant according to embodiment 4, wherein the        rotatable structure comprises a radially extending disc        comprising a plurality of magnets, and wherein the plurality of        magnets are adapted to axially be in magnetic connection with        the rotating magnetic field.    -   6. The operable implant according to embodiment 5, further        comprising a drive unit comprising a plurality of axially        positioned coils circularly distributed around a rotational axis        of the rotatable structure positioned on the inside of the        reservoir, such that the center axis of the helix of the coils        extends in the axial direction, substantially parallel or        substantially aligned in the center of the rotational axis of        the rotatable structure, and wherein sequential energizing of        the coils creates the rotating magnetic field axially propelling        the rotatable structure.    -   7. The operable implant according to embodiment 5, further        comprising a magnetic coupling comprising a driving rotatable        structure comprising a plurality of magnets circularly        distributed around a rotational axis of the rotatable structure,        wherein the driving rotatable structure is adapted to be in        magnetic connection with the rotatable structure positioned on        the inside of the reservoir, and wherein the driving rotatable        structure is connected to an electrical motor adapted to propel        the driving rotatable structure such that the rotatable        structure positioned on the inside of the reservoir rotates        along with the driving rotatable structure.    -   8. The operable implant according to embodiment 4, wherein the        rotatable structure comprises an axially extending cylinder        comprising a plurality of magnets positioned on the peripheral        surface of the cylinder, and wherein the plurality of magnets        are adapted to radially be in magnetic connection with the        rotating magnetic field.    -   9. The operable implant according to embodiment 8, further        comprising a drive unit comprising a plurality of radially        positioned coils circularly distributed around a rotational axis        of the rotatable structure positioned on the inside of the        reservoir, such that the center axis of the helix of the coils        are extending in the radial direction, substantially        perpendicular to the rotational axis of the rotatable structure,        and wherein sequential energizing of the coils creates the        rotating magnetic field propelling the rotatable structure.    -   10. The operable implant according to embodiment 8, further        comprising a drive unit comprising an driving rotatable        structure comprising a plurality of magnets circularly        distributed around a rotational axis of the rotatable structure,        wherein the driving rotatable structure is adapted to radially        be in magnetic connection with the rotatable structure        positioned on the inside of the reservoir, and wherein the        driving rotatable structure is connected to an electrical motor        adapted to propel the driving rotatable structure such that the        rotatable structure positioned on the inside of the reservoir        rotates along with the driving rotatable structure, adapted to        rotate radially on the outside thereof.    -   11. The operable implant according to any one of embodiments 6,        7, 9 and 10, wherein the drive unit is an external drive unit        adapted to be positioned on the outside of the skin of the        patient and propel the rotatable structure in the hydraulic        operation device.    -   12. The operable implant according to any one of the preceding        embodiments, wherein the hydraulic operation device comprises an        electrical motor adapted to propel the operable element of the        gear system, wherein the electrical motor is an electrical motor        selected from:        -   a. an alternating current (AC) electrical motor,        -   b. a direct current electrical motor,        -   c. a linear electrical motor,        -   d. an axial electrical motor,        -   e. a radial motor        -   f. a three phase motor        -   g. a more than one phase motor        -   h. a piezo-electric motor,        -   i. a bimetal motor, and        -   j. a memory metal motor.    -   13. The operable implant according to embodiment 12, wherein the        electrical motor is adapted to be positioned on the inside of        the reservoir.    -   14. The operable implant according to any one of the preceding        embodiments, further comprising a force transferring member,        adapted to at least one of; penetrating a wall of the fluid        reservoir, not penetrating a wall of the reservoir, transferring        force from outside of the reservoir to inside of the reservoir,        and transferring force between the motor and gear system inside        the reservoir.    -   15. The operable implant according to embodiment 14, wherein the        force transferring member is connected to an implantable        electrical motor and to the operable element of the gear system        and adapted to transfer rotational force from the electrical        motor to the operable element.    -   16. The operable implant according to any one of the preceding        embodiments, further comprising a second gear system comprising:        -   i. an operable element,        -   ii. a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   iii. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the at least one position and thereby            causes relative rotation between the first gear and the            second gear, wherein        -   b. the first gear of the first gear system is connected to            the operable element of the second gear system, such that            the first and second gear systems functions as a single gear            system.    -   17. The operable implant according to any one of the preceding        embodiments, wherein the operable element of at least one of the        first and second gear systems comprises at least one of; a        planet gear and a wheel or structure adapted to use frictional        connection direct or indirect between the operable element and        the first gear.    -   18. The operable implant according to any one of the preceding        embodiments, wherein the hydraulic operation device further        comprises at least one receiving unit adapted to receive        wireless energy supplied from outside the body of the patient.    -   19. The operable implant according to embodiment 18, wherein the        receiving unit comprises at least one coil adapted to transform        wireless energy received in form of a magnetic or        electromagnetic field into electrical energy.    -   20. The operable implant according to any one of embodiments 18        and 19, further comprising a distance element adapted to create        a distance between the receiving unit and at least one of; the        reservoir and the electrical motor, such that the receiving unit        remains substantially unaffected by metallic and/or magnetic        parts of the reservoir and/or electrical motor.    -   21. The operable implant according to embodiment 20, wherein the        distance element is adapted to at least one of; be placed        through the muscular layers of the abdominal wall and be fixated        to the fascia of a muscle facing the inside of the subcutaneous        space.    -   22. The operable implant according to any one of embodiments 20        and 21, wherein the distance element is flexible such that the        wireless energy receiver can move in relation to the reservoir        and/or electrical motor.    -   23. The operable implant according to any one of embodiments        19-21, wherein the distance element is adapted to be fixated to        at least one muscular layer of the abdominal wall, such that at        least one of; the distance between the first portion of the        implantable unit and the skin of the patient can be controlled        and the movement of the distance element including rotation is        minimized.    -   24. The operable implant according to any one of the preceding        embodiments, further comprising an injection port for directly        or indirectly supplying fluid to the reservoir or the operable        implant, being hydraulically operated.

Numbered Embodiment J 1-21

-   -   1. An implantable electrical generator for transforming        mechanical work to electrical energy, the implantable electrical        generator comprising:        -   a movable structure comprising at least one magnet or at            least one magnetic material or at least one magnetizable            material, the movable structure being adapted to be in            magnetic connection with an external drive unit creating a            moving magnetic field, such that the movable structure moves            along with the moving magnetic field, and        -   an electrical generator unit connected to the movable            structure and being adapted to transform the movements of            the movable structure to electrical energy.    -   2. The implantable electrical generator according to embodiment        1, wherein the electrical generator unit comprises:        -   at movable generator portion comprising at least one magnet,            wherein the movable generator portion is connected to the            movable structure, and        -   at least one coil in magnetic connection with the at least            one magnet,        -   wherein the electrical current is induced in the coil by the            movement of the movable generator portion in relation to the            coil.    -   3. The implantable electrical generator according to embodiment        2, wherein the movable structure comprises a rotatable disc, and        wherein the at least one magnet or magnetic material is        positioned on the rotatable disc and adapted to be in magnetic        connection with an external unit creating a rotating magnetic        field, and wherein the electrical generator unit is a rotating        electrical generator unit connected to the rotatable disc, such        that the rotating electrical generator unit rotates along with,        or is part of, the rotatable disc for inducing electrical        current.    -   4. The implantable electrical generator according to embodiment        1, wherein the movable structure is adapted to perform        reciprocating movement, and wherein the movable structure is        adapted to be in magnetic connection with an external unit        creating a reciprocating magnetic field, such that the movable        structure performs reciprocating movement along with the        reciprocating magnetic field.    -   5. The implantable electrical generator according to embodiment        4, wherein the movable structure is connected to an elastic        element or spring, such that the movable structure can operate        in a first direction by the magnetic force supplied by the        external unit, and in a second direction by the elastic element        or spring.    -   6. The implantable electrical generator according to embodiment        5, wherein the elastic element comprises at least one of; an        elastic material, a flexible material, a construction adapted to        create elastic movement, and a spring.    -   7. The implantable electrical generator according to embodiment        4, wherein the electrical generator unit is a linear electrical        generator unit comprising:        -   a movable generator portion comprising at least one magnet,            wherein the movable generator portion is in connection with            the movable structure adapted to perform reciprocating            movement, and        -   at least one coil in magnetic connection with the at least            one magnet, such that reciprocating movement of the movable            structure propagates to the movable generator portion and            induces current in the at least one coil.    -   8. The implantable electrical generator according to any one of        the preceding embodiments, further comprising a battery        connected to the electrical generator unit, wherein the battery        is adapted to store electrical energy generated in the generator        unit.    -   9. The implantable electrical generator according to any one of        the preceding embodiments, further comprising an enclosure        adapted to hermetically enclose the implantable electrical        generator, such that the implantable electrical generator is        sealed from the bodily fluids of the patient.    -   10. The implantable electrical generator according to any one of        the preceding embodiments, further comprising a wireless        communication unit adapted to at least one of:        -   receive wireless communication signals from an external            unit, and        -   transmit wireless communication signals to an external unit.    -   11. The implantable electrical generator according to any one of        the preceding embodiments, wherein the implantable electrical        generator is adapted to be implanted subcutaneously.    -   12. The implantable electrical generator according to embodiment        11, wherein the implantable electrical generator is adapted to        be implanted subcutaneously in the abdomen.    -   13. An external unit for supplying force to an implantable        electrical generator, the external unit comprising an external        drive unit adapted to create a moving magnetic field on the        outside of the patient's skin adapted to affect at least one        magnet or at least one magnetic material or at least one        magnetizable material of an implantable electrical generator,        such that the magnet or magnetic material moves along with the        moving magnetic field of the external drive unit.    -   14. The external unit according to embodiment 13, wherein the        external drive unit comprises at least one an electro magnet        adapted to be alternatingly energized and not energized, such        that an alternating magnetic field is created for affecting at        least one magnet or magnetic material of the implantable        electrical generator.    -   15. The external unit according to embodiment 13, wherein the        external drive unit comprises at least one permanent magnet, and        wherein a positive pole of a permanent magnet is adapted to        affect a permanent magnet of the implantable generator, and a        negative pole of a permanent magnet is adapted to affect a        permanent magnet of the implantable generator, and wherein the        at least one permanent magnet is adapted to move such that the        positive and negative pole alternatingly affects the permanent        magnet of the implantable generator.    -   16. The external unit according to embodiment 13, wherein the        external drive unit comprises a set of circularly distributed        coils, such that sequential energizing of the coils creates a        rotating magnetic field adapted to affect the magnet, magnetic        material, or magnetizable material of the implantable electrical        generator, such that the magnet, magnetic material, or        magnetizable material rotates along with the rotating magnetic        field of the external drive unit.    -   17. The external unit according to embodiment 13, wherein the        external unit comprises a set of linearly distributed coils,        such that sequential energizing of the coils creates a linearly        moving magnetic field adapted to affect the magnet or magnetic        material or magnetizable material of the implantable electrical        generator, such that the magnet, magnetic material, or        magnetizable material moves along with the linear magnetic field        of the external unit.    -   18. The external unit according to any one of embodiments 13 and        15, wherein the external unit comprises a rotatable structure        comprising at least one magnet or magnetic material, and wherein        rotation of the rotatable structure affects a magnet or magnetic        material of the implantable electrical generator causing        rotation thereof, such that the magnet or magnetic material        rotates along with the rotatable structure of the external unit.    -   19. The external unit according to embodiment 13, wherein the        external drive unit comprises a reciprocating structure        comprising at least one of: magnetic material, a permanent        magnet, and an electromagnet, and wherein the reciprocating        structure; a) moves the magnetic material, permanent magnet or        electromagnet between a first position close to the skin of the        patient, and a second position further from the skin of the        patient, such that a reciprocating magnetic field adapted to        affect the magnet or magnetic material of the implantable        electrical generator is created or b) is adapted to        intermittently receive electric pulses to the at least one        electromagnet to cause movement of the magnetic field, while the        reciprocating structure substantially stands still.    -   20. The external unit according to any one of embodiments 13-19,        further comprising a wireless communication unit adapted to at        least one of:        -   receive wireless communication signals from the implantable            electrical generator, and        -   transmit wireless communication signals to the implantable            electrical generator.    -   21. A system for generating electrical current inside of the        body of a patient, the system comprises:        -   an implantable electrical generator according to any one of            embodiments 1-12, and        -   an external unit according to any one of embodiments 13-20.

Numbered Embodiment K 1-24

-   -   1. An operable hydraulic implant comprising a hydraulic        operation device, the hydraulic operation device comprising an        enclosure adapted to hermetically enclose:        -   a. a reservoir adapted to contain a hydraulic fluid for            operating the operable hydraulic implant, and        -   b. a gear system adapted receive mechanical work of a first            force and velocity as input, and output mechanical work            having a different force and velocity, wherein the reservoir            and the gear system is sealed from the bodily fluids when            implanted.    -   2. The operable hydraulic implant according to embodiment 1,        wherein the reservoir comprises at least one movable wall        portion, for changing the volume of the reservoir.    -   3. The operable hydraulic implant according to embodiment 2,        wherein the gear system is connected to the movable wall for        changing the volume of the reservoir.    -   4. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising an electrical motor        connected to the gear system and enclosed by the enclosure.    -   5. The operable hydraulic implant according to any one of the        preceding embodiments, wherein the gear system comprises:        -   a. an operable element,        -   b. a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   c. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear.    -   6. The operable hydraulic implant according to embodiment 5,        wherein the operable element of the gear system is adapted to        receive mechanical work of a first force and velocity from the        electrical motor according to embodiment 4, and wherein the        first gear of the gear system is directly or indirectly        connected to the at least one movable wall portion for supplying        mechanical work having a different second force and velocity to        the at least one wall portion, such that operation of the        electrical motor moves the movable wall portion and changes the        volume of the reservoir.    -   7. The operable hydraulic implant according to embodiment 6,        wherein the first gear of the gear system directly or indirectly        connects to a threaded member adapted to transform the radially        rotating force to an axially reciprocating force, and wherein        the threaded member is directly or indirectly connected to the        movable wall portion for changing the volume of the reservoir.    -   8. The operable hydraulic implant according to embodiment 7,        wherein the threaded member is directly or indirectly connected        to a movable wall portion of a second fluid reservoir for        changing the volume of the second reservoir.    -   9. The operable hydraulic implant according to embodiment 8,        wherein the movement of the movable wall portion of the first        reservoir, by the threaded member in a first direction causes        the first reservoir to expand and the volume in the first        reservoir to increase, and wherein the movement of the movable        wall portion of the second reservoir by the threaded member in a        first direction causes the second reservoir to contract and the        volume in the second reservoir to decrease.    -   10. The operable hydraulic implant according to embodiment 9,        wherein the first reservoir is in fluid connection with a first        hydraulically operable body engaging portion, and wherein the        second reservoir is in fluid connection with a second        hydraulically operable body engaging portion, and wherein        operation of the electrical motor unit in a first direction, by        the connection with the threaded member, causes:        -   a. transportation of fluid from the first reservoir to the            first hydraulically operable body engaging portion, and        -   b. transportation of fluid from the second hydraulically            operable body engaging portion to the second reservoir.    -   11. The operable hydraulic implant according to any one of the        preceding embodiments, wherein a wall of the enclosure        constitutes at least a portion of the wall of the reservoir, and        wherein at least one movable wall portion is positioned between        the reservoir and the gear system, such that the portion of the        at least one movable wall portion separates the reservoir from a        portion of the enclosure enclosing the gear system, such that        the gear system is sealed from the reservoir.    -   12. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising a second gear system        enclosed by the enclosure, wherein the second gear system is        adapted to receive mechanical work of the different second force        and velocity from the output of the first gear system, and        output mechanical work having a different third force and        velocity.    -   13. The operable hydraulic implant according to embodiment 12,        wherein the second gear system comprises:        -   a. an operable element,        -   b. a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   c. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, and            wherein the first gear of the first gear system is directly            or indirectly connected to the operable element of the            second gear system, such that the first and second gear            systems functions as a single gear system.    -   14. The operable implant according to any one of the preceding        embodiments, wherein the operable element of at least one of the        first and second gear systems comprises at least one of; a        planet gear and a wheel or structure using a frictional        connection.    -   15. The operable hydraulic implant according to any one of        embodiments 4-14, further comprising at least one battery,        enclosed by the enclosure, and adapted to energize the        electrical motor.    -   16. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising a receiving unit        adapted to receive wireless energy transmitted from outside the        patient's body.    -   17. The operable hydraulic implant according to embodiment 16,        wherein the receiving unit is enclosed by the enclosure, such        that the receiving unit is sealed from the bodily fluids.    -   18. The operable hydraulic implant according to any one of        embodiment 16 and 17, further comprising a distance element        adapted to create a distance between the receiving unit and at        least one of; the gear system and the electrical motor, such        that the receiving unit is removed from metallic and/or magnetic        components of the gear system and/or electrical motor.    -   19. The operable hydraulic implant according to any one of        embodiments 16-18, wherein the receiving unit is adapted to        charge the battery according to embodiment 15.    -   20. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising a magnetic coupling        comprising a first part connected to the operable element of the        gear system and enclosed by the enclosure, and a second part        being:        -   a. positioned on the outside of the enclosure,        -   b. connected to an electrical motor positioned such that            operation of the electrical motor operates the second part            of the magnetic coupling, and        -   c. magnetically connected to the first part of the magnetic            coupling, such that the first part of the magnetic coupling            rotates along with the second part of the magnetic coupling,            such that the electrical motor propels the gear system            through the wall of the enclosure.    -   21. The operable hydraulic implant according to embodiment 20,        further comprising an implanted electrical motor, and wherein        the second part is connected to the implantable electrical        motor.    -   22. The operable hydraulic implant according to embodiment 20,        wherein the second part of the magnetic coupling is connected to        an external drive unit adapted to propel the first unit from the        outside of the patient's body.    -   23. The implantable hydraulic unit according to any one of        embodiments 4-22, wherein the electrical motor is an electrical        motor selected from:        -   a. an alternating current (AC) electrical motor,        -   b. a direct current electrical motor,        -   c. a linear electrical motor,        -   d. an axial electrical motor,        -   e. a radial motor        -   f. a three-phase motor        -   g. a more than one-phase motor        -   h. a piezo-electric motor,        -   i. a bimetal motor, and        -   j. a memory metal motor.    -   24. The implantable hydraulic unit according to any one of the        preceding embodiments, wherein the enclosure comprises a        material selected from:        -   a. a carbon material        -   b. a boron material        -   c. a mixture of material        -   d. a Peek® material        -   e. an alloy of material        -   f. a metallic material,        -   g. titanium,        -   h. aluminum,        -   i. a ceramic material,        -   j. a polymer material,        -   k. polyurethane,        -   l. polyether ether ketone,        -   m. silicone, and        -   n. Parylene® coated silicone.

Numbered Embodiment L 1-23

-   -   1. An operable implant for implantation in the body of a        patient, the operable implant comprising:        -   a. at least one fixation member adapted to directly or            indirectly fixate the operable implant towards at least one            of; at least one muscular fascia, at least one bone fascia,            at least one cortical bone layer, at least one muscular            layer, fibrotic tissue, any part of the abdominal wall, and            any part of the subcutaneous space and it's surroundings in            the body, and        -   b. at least one adjustable distance element adapted to;            -   i. in one end thereof, be directly or indirectly                connected to at least a part of the operable implant,            -   ii. in the other end thereof, be directly or indirectly                connected to the fixation member, and            -   iii. adjust the distance between the part of the                operable implant connected to the adjustable distance                element, and the fixation member.    -   2. The operable implant according to embodiment 1, comprising at        least one part selected from a list consisting of:        -   a. an operation device,        -   b. a control unit        -   c. a receiving unit, for receiving wireless energy,        -   d. a coil, for receiving wireless energy,        -   c. a receiving unit, for receiving a magnetic field or an            electromagnetic field,        -   f. a magnetic force transferring coupling,        -   g. an electrical circuit,        -   h. a push button for controlling any function of the            operable implant,        -   i. an energy storage device,        -   j. a pushable construction for adjusting the adjustable            distance element,        -   k. an integrated operation device and receiving unit, for            receiving wireless energy or a magnetic field or an            electromagnetic field adapted to generate kinetic energy,        -   l. a casing for enclosing at least one of the different            parts of the operable implant        -   m. two or more casings for enclosing at least one of the            different parts of the operable implant in each casing, and        -   n. an integrated unit comprising two or more of the parts            according to points a-k above, and wherein        -   the at least one adjustable distance element is adapted to            adjust the distance between:            -   the fixation member, and            -   at least one part of points a-n above.    -   3. The operable implant according to embodiment 1, wherein the        at least one fixation member is integrated with at least one of:        -   a. an operation device,        -   b. a control unit        -   c. a receiving unit, for receiving wireless energy,        -   d. a coil, for receiving wireless energy,        -   e. a receiving unit, for receiving a magnetic field or an            electromagnetic field,        -   f. a magnetic force transferring coupling,        -   g. an electrical circuit,        -   h. a push button for controlling any function of the            operable implant,        -   i. an energy storage device,        -   j. a pushable construction for adjusting the adjustable            distance element,        -   k. an integrated operation device and receiving unit, for            receiving wireless energy or a magnetic field or an            electromagnetic field adapted to generate kinetic energy,        -   l. a casing for enclosing at least one of the different            parts of the operable implant        -   m. two or more casings for enclosing at least one of the            different parts of the operable implant in each casing, and        -   n. an integrated unit comprising two or more of the parts            according to point a k above, and wherein        -   the at least one adjustable distance element is adapted to            adjust the distance between;            -   the fixation member integrated with one or more of the                parts of the operable implant, described in points a-n                above, and            -   one or more parts of the operable implant described in                embodiment 2.    -   4. The operable implant according to any one of embodiments 1-3,        wherein the at least one adjustable distance element is        adjustable from outside the body of the patient.    -   5. The operable implant according to embodiment 4, wherein the        at least one adjustable distance element is adjustable        electrically or manually from outside the body of the patient.    -   6. The operable implant according to any one of the preceding        embodiments, wherein the at least one adjustable distance        element, comprises two, three, four or more adjustable distance        elements.    -   7. The operable implant according to any one of the preceding        embodiments, wherein the at least one adjustable distance        element comprises a threaded member for transferring a rotating        movement to a linear movement for adjusting the distance.    -   8. The operable implant according to any one of the preceding        embodiments, wherein the at least one adjustable distance        element or operable implant, comprising an x-ray detectable        element, such that the distance adjusted by the at least one        adjustable distance element can be measured on an x-ray image.    -   9. The operable implant according to any one of the preceding        embodiments, wherein the at least one adjustable distance        element or operable implant, comprising an element detectable by        means of ultrasound, such that the distance adjusted by the at        least one adjustable distance element can be measured by means        of ultrasound.    -   10. The operable implant according to any one of embodiments        2-9, wherein the at least one part of the operable implant is        adapted to be placed subcutaneously.    -   11. The operable implant according to any one of embodiments        2-9, wherein the operation device is adapted to be placed        subcutaneously.    -   12. The operable implant according to any one of the preceding        embodiments, wherein the operation device is adapted to be        fixated to at least one of, at least one fascia layer and at        least one muscular layer of the abdominal wall.    -   13. The operable implant according to any one of the preceding        embodiments, wherein the at least one adjustable distance        element is adapted to be placed through at least one of, at        least one fascia layer and at least one muscular layer of the        abdominal wall.    -   14. The operable implant according to any one of the preceding        embodiments, wherein the at least one adjustable distance        element is flexible such that the different parts of the        operable implant can flex in relation to each other.    -   15. The operable implant according to any one of embodiments        2-14, wherein the receiving unit comprises at least one coil        adapted to transform wireless energy, received in form of an        electric, magnetic or electromagnetic field, into electrical        energy.    -   16. The operable implant according to embodiment 15, wherein the        receiving unit comprises at least a first coil having a first        number of windings, and at least a second coil having a second,        different number of windings.    -   17. The operable implant according to any one of the preceding        embodiments, comprising at least one enclosure adapted to        hermetically enclose at least one part according to embodiment 2        and the adjustable distance element.    -   18. The operable implant according to any one of the preceding        embodiments, comprising at least one enclosure adapted to        hermetically enclose at least one part according to embodiment        2.    -   19. The operable implant according to any one of the preceding        embodiments, wherein the at least one adjustable distance        element comprises a lead for transferring electrical current        from the receiving unit to the operation device.    -   20. The operable implant according to any one of the preceding        embodiments, further comprising a control unit for controlling        at least one parameter of the operable implant.    -   21. The operable implant according to embodiment 20, wherein the        control unit is adapted to wirelessly communicate with an        external unit, such that the control unit can be wirelessly        controlled from outside the body.    -   22. The operable implant according to any one of the preceding        embodiments, wherein at least one of; the receiving unit        according to embodiment 2 and the at least one adjustable        distance element is free from magnetic components.    -   23. The operable implant according to any one of embodiments        17-18, wherein the at least one enclosure comprises two or more        enclosures, wherein the at least one adjustable distance element        is adapted to adjust the distance between the enclosures.

Numbered Embodiment M 1-24

-   -   1. A surgical kit for an operable implant enabling adjustment of        a distance between at least one fixation member of the operable        implant and at least one part of the operable implant, the        surgical kit comprises:        -   a. at least one first distance element having:            -   i. a first connecting portion adapted to directly or                indirectly connect to the at least one part of the                operable implant, and            -   ii. a second connecting portion adapted to directly or                indirectly connect to the at least one fixation member                of the operable implant, for creating a first distance                between the at least one part of the operable implant                and the at least one fixation member of the operable                implant, and        -   b. at least one second distance element having:            -   i. a first connecting portion adapted to directly or                indirectly connect to at least one part of the operable                implant, and            -   ii. a second connecting portion adapted to directly or                indirectly connect to the at least one fixation member                of the operable implant for creating a second longer                distance between the at least one part of the operable                implant and the at least one fixation member of the                operable implant.    -   2. The surgical kit according to embodiment 1, wherein at least        one of; the at least one first and second distance elements        comprises an x-ray detectable element, such that the distance        between the at least one part of the operable implant and the at        least one fixation member of the operable implant can be        measured on an x-ray image.    -   3. The surgical kit according to embodiment 1, wherein at least        one of; the at least one first and second distance elements        comprises an element detectable by means of ultrasound, such        that the distance between the at least one part of the operable        implant and the at least one fixation member of the operable        implant can be measured by means of ultrasound.    -   4. The surgical kit according to any one of the preceding        embodiments, wherein at least one of; the at least one first and        second distance elements is adapted to be placed subcutaneously.    -   5. The surgical kit according to any one of the preceding        embodiments, wherein at least one of; the at least one the first        and second distance elements is adapted to be fixated to at        least one of; at least one muscular fascia, at least one bone        fascia, at least one cortical bone layer, at least one muscular        layer, fibrotic tissue, any part of the abdominal wall, and any        part of the subcutaneous space and it's surroundings in the        body.    -   6. The surgical kit according to embodiment 5, wherein at least        one of the first and second distance elements is adapted to        create a distance between the muscular layer of the abdominal        wall and an operation device of the operable implant.    -   7. The surgical kit according to any one of the preceding        embodiments, wherein at least one of the first and second        distance elements are adapted to be placed through at least one        of, at least one fascia layer and at least one muscular layer of        the abdominal wall.    -   8. The surgical kit according to any one of the preceding        embodiments, wherein at least one of the first and second        distance elements is flexible such that the different parts of        the operable implant can move in relation to each other.    -   9. The surgical kit according to any one of the preceding        embodiments, wherein at least one of the first and second        distance elements is free from magnetic components.    -   10. The surgical kit according to any one of embodiments 1-9,        wherein at least one of the first and second distance element is        adapted to guide a lead for transferring electrical current from        a wireless energy receiving unit to an operation device of the        operable implant.    -   11. The surgical kit according to any one of the preceding        embodiments, wherein at least one of; the first and second        distance element is adapted to fixate a wireless energy        receiving unit in the body of the patient in an optimal position        and hinder the body from rejecting the wireless energy receiving        unit.    -   12. A system for adjusting a distance in an operable implant,        the system comprising the surgical kit according to any one of        embodiments 1-11 and an operable implant comprising at least one        fixation member and at least one part selected from a list        consisting of:        -   a. an operation device,        -   b. a control unit,        -   c. a receiving unit, for receiving wireless energy,        -   d. a coil, for receiving wireless energy,        -   e. a receiving unit, for receiving a magnetic field or an            electromagnetic field,        -   f. a magnetic force transferring coupling,        -   g. an electrical circuit,        -   h. a push button for controlling any function of the            operable implant,        -   i. an energy storage device,        -   j. a pushable construction for adjusting the adjustable            distance element,        -   k. an integrated operation device and receiving unit, for            receiving wireless energy or a magnetic field or an            electromagnetic field adapted to generate kinetic energy,        -   l. a casing for enclosing at least one of the different            parts of the operable implant,        -   m. two or more casings for enclosing at least one of the            different parts of the operable implant in each casing, and        -   n. an integrated unit comprising two or more of the parts            according to point a-k above, and wherein        -   at least one of the first and second distance elements is            adapted to create a distance between the fixation member and            at least one of the parts a-n above.    -   13. A system according to embodiment 12, wherein the at least        one fixation member is integrated with at least one of:        -   a. an operation device,        -   b. a control unit        -   c. a receiving unit, for receiving wireless energy,        -   d. a coil, for receiving wireless energy,        -   e. a receiving unit, for receiving a magnetic field or an            electromagnetic field,        -   f. a magnetic force transferring coupling,        -   g. an electric circuit,        -   h. a push button for controlling any function of the            operable implant,        -   i. an energy storage device,        -   j. a pushable construction for adjusting the adjustable            distance element,        -   k. an integrated operation device and receiving unit, for            receiving wireless energy or a magnetic field or an            electromagnetic field adapted to generate kinetic energy,        -   l. a casing for enclosing at least one of the different            parts of the operable implant        -   m. two or more casings for enclosing at least one of the            different parts of the operable implant in each casing, and        -   n. an integrated unit comprising two or more of the parts            according to a-k above, and wherein        -   wherein at least one of; the first and second distance            element is adapted to create a distance between;            -   the fixation member integrated with one or more of parts                a-n above, and            -   one or more other parts of the operable implant of                embodiment 12.    -   14. The system according to any one of embodiments 12-13,        wherein at least one of the first and second distance elements        comprises a lead for transferring electrical current from the        wireless energy receiving unit to the operation device.    -   15. The system according to any one of embodiments 12-14,        wherein at least one part of the operable implant is adapted to        be placed subcutaneously.    -   16. The system according to any one of embodiments 12-15,        wherein the operation device is adapted to be placed        subcutaneously.    -   17. The system according to embodiment 16, wherein the operation        device is adapted to be fixated to at least one of, at least one        fascia layer and at least one muscular layer of the abdominal        wall.    -   18. The system according to any one of embodiments 12-17,        wherein the receiving unit comprises at least one coil adapted        to transform wireless energy, received in form of an electric,        magnetic or electromagnetic field, into electrical energy.    -   19. The system according to embodiment 18, wherein the receiving        unit comprises at least a first coil having a first number of        windings, and at least a second coil having a second, different        number of windings.    -   20. The system according to any one of embodiments 12-19,        comprising at least one enclosure adapted to hermetically        enclose at least any one part according to embodiment 12 and the        adjustable distance element.    -   21. The system according to any one of embodiments 12-20,        comprising at least one enclosure adapted to hermetically        enclose at least one of the parts of embodiment 12.    -   22. The system according to any one of embodiments 12-21,        wherein the control unit is adapted to control at least one        parameter of the operable implant.    -   23. The system according to embodiment 22, wherein the control        unit is adapted to wirelessly communicate with an external unit,        such that the control unit can be wirelessly controlled from        outside the body.    -   24. The system according to any one of embodiments 20-21,        wherein the at least one enclosure comprises two or more        enclosures, wherein one of the first and second distance element        is adapted to adjust the distance between the two enclosures.

Numbered Embodiment N 1-31

-   -   1. An operable implant for implantation in a patient, the        operable implant comprises a body engaging portion and an        operation device for supplying force to the body engaging        portion, the operation device comprises an implantable gear        system adapted to, at a force input; receive mechanical work of        a first force and velocity, and, at a force output; supply        mechanical work having a different second force and second        velocity to operate the body engaging portion, the gear system        comprising:        -   a. an operable element connected to the force input,        -   b. a first gear connected to the force output, first gear            having the shape of a hollow cylinder, comprising a first            number of teeth, on the peripheral outside thereof, and        -   c. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear.    -   2. The operable implant according to embodiment 1, wherein the        operable element is adapted to deflect the first gear, and to        maintain the first gear deflected such that the teeth of the        first gear are interengaged with the teeth of the second gear in        one or more angularly spaced positions interspaced by positions        at which the teeth are not interengaged.    -   3. The operable implant according to embodiment 1, wherein the        operable element is adapted to deflect the first gear, and to        maintain the first gear deflected such that the teeth of the        first gear are interengaged with the teeth of the second gear in        at least two or more angularly spaced positions interspaced by        positions at which the teeth are not interengaged.    -   4. The operable implant according to any one of embodiments 1-3,        wherein the operation device comprises an implantable electrical        motor for transforming electrical energy to mechanical work, and        wherein the electrical motor is connected to the force input.    -   5. The operable implant according to embodiment 4, wherein the        electrical motor is an electrical motor selected from:        -   a. an alternating current (AC) electrical motor,        -   b. a direct current electrical motor,        -   c. a linear electrical motor,        -   d. an axial electrical motor,        -   c. a piezo-electric motor,        -   f. a three-phase motor        -   g. a more than one-phase motor        -   h. a bimetal motor, and        -   i. a memory metal motor.    -   6. The operable implant according to any one of embodiments 1-5,        further comprising a magnetic coupling connected to the force        input, such that mechanical work of the first force and velocity        is supplied to the gear system by means of the magnetic        coupling.    -   7. The operable implant according to any one of embodiments 1-5,        further comprising a magnetic coupling connected to the force        output, such that mechanical work of the second force and        velocity is supplied to the body engaging portion by means of        the magnetic coupling.    -   8. The operable implant according to any one of embodiments 6        and 7, wherein the magnetic coupling is adapted to transfer at        least one of; rotating force and reciprocating force.    -   9. The operable implant according to any one of the preceding        embodiments, further comprising an enclosure adapted to        hermetically enclose the operable implant.    -   10. The operable implant according to any one of the preceding        embodiments, wherein the gear system comprises a third gear        having the shape of a hollow cylinder, and wherein the inside of        third gear comprises the same amount of teeth as the outside of        the first gear, and wherein teeth of the third gear are adapted        to interengage the teeth of the first gear such that the third        gear rotates in relation to the second gear, along with the at        least one interengaged position.    -   11. The operable implant according to embodiment 10, wherein the        third gear is connected to a second gear system, such that the        first and second gear systems functions as a single gear system,        the second gear system comprising:        -   a. a force input adapted to receive mechanical work of the            second force and second velocity from the force output of            the first gear system, and        -   b. a force output adapted to supply mechanical work to the            body engaging portion having a different third force and            third velocity.    -   12. The operable implant according to embodiment 11, wherein the        second gear system comprises:        -   a. an operable element connected to the force input of the            second gear system,        -   b. a first gear connected to the force output of the second            gear system, having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   c. a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the at least one position and thereby            causes relative rotation between the first gear and the            second gear    -   13. The operable implant according to any one of the preceding        embodiments, wherein the operable element of at least one of the        first and second gear systems comprises at least one of; a        planetary gear and a structure or wheel at least partly using        friction to enable rotating force to be transported.    -   14. The operable implant according to any one of the preceding        embodiments, wherein the force output of the first or second        gear system directly or indirectly connects to a threaded member        adapted to transform rotating force to linear force.    -   15. The operable implant according to embodiment 14, further        comprising a reservoir comprising a movable wall portion adapted        to change the volume of the reservoir, wherein the threaded        member is directly or indirectly connected to the movable wall        portion such that operation of the threaded member changes the        volume of the reservoir.    -   16. The operable implant according to embodiment 15, wherein the        operable implant comprises a second reservoir comprising a        movable wall portion, and wherein the threaded member is        directly or indirectly connected to the movable wall portion of        the second reservoir for changing the volume of the second        reservoir.    -   17. The operable implant according to embodiment 16, wherein the        movement of the movable wall portion of the first reservoir, by        the threaded member in a first direction causes the first        reservoir to expand and the volume of the first fluid reservoir        to increase, and wherein the movement of the movable wall        portion of the second reservoir by the threaded member in a        first direction causes the second reservoir to contract and the        volume of the second reservoir to decrease.    -   18. The operable implant according to embodiment 17, wherein the        first reservoir is in fluid connection with a first body        engaging portion, and wherein the second reservoir is in fluid        connection with a second body engaging portion, and wherein        operation of the operation device in a first direction, by the        connection with the threaded member, causes:        -   a. transportation of fluid from the first reservoir to the            first body engaging portion, and        -   b. transportation of fluid from the second body engaging            portion to the second reservoir.    -   19. The operable implant according to any one of embodiments        15-18, wherein the reservoir is at least one of circular and        torus shaped.    -   20. The operable implant according to any one of the preceding        embodiments, further comprising a peristaltic pump, wherein the        peristaltic pump comprises a hollow member for fluid        transportation, and an operable compression member adapted to        engage and compress the hollow member, and wherein the force        output in direct or indirect connection with the compression        member, such that the operation of the operation device operates        the compression member such that fluid is transported in the        hollow member.    -   21. The operable implant according to any one of the preceding        embodiments, further comprising a friction coupling adapted to        limit the torque that can be supplied by the operation device.    -   22. The operable implant according to any one of the preceding        embodiments, further comprising a friction coupling positioned        between the operation device and the body engaging portion, such        that the torque required to start the operation device is        reduced.    -   23. The operable implant according to embodiments 6, wherein the        magnetic coupling comprises a rotating element placed inside a        sealed enclosure enclosing at least the gear system of the        operable implant, the rotating element comprising at least one        magnet or a portion comprising magnetic or magnetizable        material, and wherein the magnet or portion comprising magnetic        or magnetizable material is adapted to rotate to transfer force        to a corresponding rotating element on the outside of the sealed        enclosure, for directly or indirectly supplying force to the        body engaging portion through the sealed enclosure.    -   24. The operable implant according to embodiments 7, wherein the        magnetic force coupling comprises a rotating element placed        inside a sealed enclosure comprising at least one magnet or a        portion comprising magnetic or magnetizable material, adapted to        be rotated when receiving transfer force from a corresponding        external rotating element placed on the outside of the hermetic        enclosure and on the outside of the body, for directly supplying        force to the rotating element placed inside the sealed        enclosure.    -   25. The operable implant according to any one of the preceding        embodiments, further comprising a reservoir for holding a        hydraulic fluid, the reservoir comprising a movable wall portion        adapted to change the volume of the reservoir, wherein the        movable wall portion is directly or indirectly connected to the        gear system force outlet, such that operation of the gear system        changes the volume of the reservoir.    -   26. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is a one, two, three        or more phase motor, comprising at least one of; an axial        electrical motor, a radial electrical motor, and a linear        electrical motor.    -   27. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises an        electrical motor comprising a static part comprising a plurality        of coils and a movable part comprising a plurality of magnets,        such that sequential energizing of said coils magnetically        propels the magnets and thus propels the movable part, wherein        the operation device further comprises an enclosure adapted to        hermetically enclose the coils of the static part, such that a        seal is created between the static part and the propelled moving        part with the included magnets, such that the coils of the        static part are sealed from the bodily fluids, when implanted.    -   28. The operable implant according to any one of the preceding        embodiments, comprising a separate receiving unit adapted to        receive wireless energy, the receiving unit comprising at least        one coil adapted to transform wireless energy received in form        of a magnetic, electric or electromagnetic field into electrical        energy.    -   29. The operable implant according to embodiment 28, further        comprising at least one distance element adapted to create a        distance between the receiving unit and at least one of the skin        of the patient and any metallic, magnetic or magnetizable part        of the operable implant, such that the receiving unit remains        substantially unaffected by metallic and/or magnetic parts of        the operable implant.    -   30. The operable implant according to embodiment 29, wherein the        at least one distance element is adjustable.    -   31. The operable implant according to any one of the preceding        embodiments, comprising at least one fixation member for        fixating at least a part of the operable implant to at least one        of muscular fascia, bone fascia, cortical bone, muscular layer,        fibrotic tissue, and a at least one layer towards the inside of        the subcutaneous space of the patient.

Numbered Embodiment O 1-27

-   -   1. A medical system for transferring energy from the outside of        the body of a patient to an operable implant placed inside the        body of the patient, the system comprises:        -   an external drive unit, and        -   an operable implant, wherein        -   the external drive unit comprises an external rotating            structure comprising at least one magnet for creating a            rotating magnetic field adapted to magnetically connect to            at least one of:        -   a magnet, magnetizable material or magnetic material of the            operable implant for transferring force from the external            drive unit to the magnet or magnetic material of the implant            in the body of the patient, and        -   at least one coil of the operable implant for inducing            electrical current in the body of the patient.    -   2. The medical system according to embodiment 1, wherein the        magnet or magnetic material of the operable implant is fixated        to an internal rotating structure adapted to rotate along with        the rotating magnetic field of the external drive unit for        operating the operable implant.    -   3. The medical system according to embodiment 1, wherein the        magnet or magnetic material of the operable implant is fixated        to an internal reciprocating structure adapted to reciprocate        with the rotating magnetic field of the external drive unit for        operating the operable implant.    -   4. The medical system according to embodiment 3, wherein the        internal reciprocating structure is adapted to reciprocate due        to the magnetic connection with a magnetic field which shifting        polarity, such that the magnets of the internal reciprocating        structure is alternatingly attracted and repelled by the        rotating magnetic field created by the external drive unit.    -   5. The medical system according to embodiment 2, wherein the        external rotating structure has a larger diameter than the        internal rotating structure, and wherein the magnets are        arranged such that the radial force, enabling the magnets of the        internal rotating structure to rotate along with the magnets of        the external rotating structure, is greater than the axial        force, exerted by the magnets, pressing the internal structure        against the external structure.    -   6. The medical system according to any one of the preceding        embodiments, wherein at least one of the internal rotating        structure and the external rotating structure comprises a        repelling magnet adapted to decrease the axial forces created by        the magnetic connection between the internal and external        magnets and/or magnetic material, such that the squeezing effect        on the patient's skin is reduced.    -   7. The medical system according to embodiment 6, wherein the        force of the repelling or attracting magnet is adjustable, such        that the squeezing effect on the patient's skin can be adjusted.    -   8. The medical system according to embodiment 7, wherein the        attracting magnet is an attracting electromagnet, and wherein        the force of the repelling electromagnet is adjusted by altering        the current to the electromagnet.    -   9. The medical system according to embodiment 7, wherein the        repelling magnet is a permanent magnet and wherein the force of        the repelling permanent magnet is adjusted by altering distance        between or position of the permanent magnet in relation to the        patient's skin.    -   10. The medical system according to any one of embodiments 2 and        5-9, wherein the internal rotating structure comprises an        internal spherical cap, and wherein the magnets or magnetic        material of the internal rotating structure is positioned on the        outside of said internal spherical cap, and wherein the external        rotating structure comprises an external spherical cap, and        wherein the magnets or magnetic material of the external        rotating structure is positioned on inside of said external        spherical cap, such that rotating force can be transferred        radially by means of the magnetic connection between the        internal and external spherical caps.    -   11. The medical system according to embodiment 10, wherein the        internal spherical cap comprises a centrally placed magnet, and        the external spherical cap comprises a centrally placed magnet,        and wherein the magnets of the internal and external spherical        caps are adapted to exert repelling forces on each other such        that the axial forces created by the magnetic connection between        the internal and external magnets and/or magnetic material is        reduced, such that the squeezing effect on the patient's skin is        reduced.    -   12. The medical system according to any one of embodiments 2-11,        further comprising a gear system connected to the internal        rotating structure, the gear system being adapted to receive        mechanical work of a first force and velocity and supply        mechanical work having a different force and velocity.    -   13. The medical system according to embodiment 12, wherein the        gear system comprises:        -   a. an operable element,        -   b. a first gear comprising a first number of teeth, on the            outside thereof, and        -   c. a second gear comprising a greater number of teeth than            the first gear, on the inside thereof, wherein the operable            element is adapted to press the outside of the first gear            towards the inside of the second gear such that the teeth of            the first gear are interengaged with the teeth of the second            gear in at least one position interspaced by positions at            which the teeth are not interengaged, and wherein the            operation of the operable element advances the positions and            thereby causes relative rotation between the first gear and            the second gear.    -   14. The medical system according to embodiment 1-13, wherein the        operable implant comprises an operation device and a body        engaging portion.    -   15. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises a hydraulic        operation device.    -   16. The operable implant according to embodiment 15, wherein the        body engaging portion is a hydraulically operable body engaging        portion, and wherein the operable implant further comprises        hydraulic pump and a reservoir adapted to hold hydraulic fluid,        the reservoir being connected to the hydraulic pump, and wherein        the hydraulic pump is adapted to transport hydraulic fluid from        the reservoir to the body engaging portion.    -   17. The operable implant according to any one of embodiments 15,        wherein the hydraulic pump comprises a movable wall portion of        the reservoir, and wherein the hydraulic pump is adapted to        transport hydraulic fluid from the reservoir to the        hydraulically operable body engaging portion by moving the        movable wall portion and thereby changing the volume of the        reservoir.    -   18. The operable implant according to embodiment 14, wherein        operation device comprises an electrical motor comprising a        static part comprising a plurality of coils and a movable part        comprising a plurality of magnets, such that sequential        energizing of said coils magnetically propels the magnets and        thus propels the movable part, wherein the operation device        further comprises an enclosure adapted to hermetically enclose        the coils of the static part, such that a seal is created        between the static part and the propelled moving part with the        included magnets, such that the coils of the static part are        sealed from the bodily fluids, when implanted.    -   19. The medical system according to any one of the preceding        embodiments, further comprising an implantable electrical        generator comprising:        -   at movable generator portion comprises at least one            generator magnet connected to the magnet or magnetic            material of the operable implant, such that the movement of            the magnet or magnetic material moves the movable generator            portion, and        -   at least one coil in magnetic connection with the at least            one generator magnet,        -   such that electrical current is induced in the coil by the            movement of the movable generator portion in relation to the            coil.    -   20. The medical system according to embodiment 19, wherein the        movable generator portion is adapted to perform rotating        movements.    -   21. The medical system according to embodiment 20, wherein the        implantable electrical generator is an implantable rotational        electrical generator, and wherein the movable generator portion        is adapted to perform rotating movement, and wherein the at        least one coil is in magnetic connection with the at least one        magnet, such that rotating movement of the movable generator        portion induces current in the at least one coil.    -   22. The medical system according to embodiment 19, wherein the        movable generator portion is adapted to perform reciprocating        movements.    -   23. The medical system according to embodiment 22, wherein the        implantable electrical generator is an implantable linear        electrical generator, and wherein the movable generator portion        is adapted to perform reciprocating movement, and wherein the at        least one coil is in magnetic connection with the at least one        magnet, such that reciprocating movement of the movable        generator portion induces current in the at least one coil.    -   24. The medical system according to embodiment 1, wherein the        operable implant comprises a plurality of coils arranged in a        circular configuration, such that the rotating magnetic field by        the external drive unit sequentially induces electrical current        in the plurality of coils.    -   25. The medical system according to any one of embodiments 1 and        19-24, further comprising at least one battery or energy storage        device connected to the at least one coil, such that the current        induced in the at least one coil can be stored as electrical        energy in the battery.    -   26. The medical system according to any one of the preceding        embodiments, further comprising an enclosure adapted to        hermetically enclose the operable implant, such that the        operable implant is sealed from the bodily fluids of the        patient.    -   27. The medical system according to any one of the preceding        embodiments, wherein the operable implant is adapted to be        implanted subcutaneously.

Numbered Embodiment P 1-25

-   -   1. An operable implant adapted to be implanted in the body of a        patient, the operable implant comprising an operation device and        a body engaging portion, the operation device comprising:        -   a movable part directly or indirectly connected to the body            engaging portion, the movable part being connected to at            least one magnet, magnetizable material or magnetic            material, wherein the movable part is adapted to            magnetically connect to a moving magnetic field on the            outside of the patient's body, such that the movable part            moves along with the movable magnetic field,        -   an implantable generator connected to the movable part and            adapted to transform movement to electrical current, such            that the movement of the movable part operates the body            engaging portion and generates electrical current.    -   2. The operable implant according to embodiment 1, wherein the        at least one magnet, magnetizable material or magnetic material        is connected to a rotating structure and adapted to magnetically        connect to a rotating magnetic field on the outside of the skin        of the patient, such that the rotating structure rotates along        with the rotating magnetic field.    -   3. The operable implant according to embodiment 1, wherein the        at least one magnet, magnetizable material or magnetic material        is connected to a structure adapted for reciprocating movement        and adapted to magnetically connect to a reciprocating magnetic        field on the outside of the skin of the patient, such that the        structure for reciprocating movement moves along with the        reciprocating magnetic field.    -   4. The operable implant according to any one of the preceding        embodiments, wherein the implantable generator comprises at        least one magnet and at least one coil, and wherein the movement        of the at least one magnet in relation to the at least one coil        induces an electrical current in the at least one coil, and        wherein at least one magnet of the movable part adapted to        magnetically connect to a moving magnetic field on the outside        of the patient's body, also functions as the at least one magnet        in the implantable generator.    -   5. The operable implant according to any one of the preceding        embodiments, further comprising a battery or energy storage        adapted to be charged by the implantable generator.    -   6. The operable implant according to embodiment 5, wherein the        battery or energy storage is adapted to power the body engaging        portion.    -   7. The operable implant according to any one of the preceding        embodiments, further comprising a control unit for controlling        at least one parameter of the operable implant.    -   8. The operable implant according to embodiment 7, wherein the        control unit is connected to the battery or energy storage of        embodiment 5, and wherein the battery powers the control unit.    -   9. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises a hydraulic        operation device.    -   10. The operable implant according to embodiment 9, wherein the        body engaging portion is a hydraulically operable body engaging        portion, and wherein the operable implant further comprises        hydraulic pump and a reservoir adapted to hold hydraulic fluid,        the reservoir being connected to the hydraulic pump, and wherein        the hydraulic pump is adapted to transport hydraulic fluid from        the reservoir to the body engaging portion.    -   11. The operable implant according to any one of embodiments 9,        wherein the hydraulic pump comprises a movable wall portion of        the reservoir, and wherein the hydraulic pump is adapted to        transport hydraulic fluid from the reservoir to the        hydraulically operable body engaging portion by moving the        movable wall portion and thereby changing the volume of the        reservoir.    -   12. The operable implant according to embodiment 10, wherein the        hydraulic pump is a hydraulic pump selected from:        -   peristaltic pumps,        -   membrane pumps,        -   gear pumps, and        -   bellows pumps.    -   13. The operable implant according to any one of the preceding        embodiments, wherein the operation device comprises a gear        system adapted to receive mechanical work of a first force and        velocity as input, and output mechanical work having a different        force and velocity.    -   14. The operable implant according to embodiment 13, wherein the        a gear system comprises:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear.    -   15. The operable implant according to embodiment 14, wherein the        operable element is connected to the movable part, such that the        movement of the movable part operates        -   the gear system.    -   16. The operable implant according to any one of the preceding        embodiments, wherein operable implant further comprises an        enclosure adapted to enclose the operable implant.    -   17. The operable implant according to any one of the preceding        embodiments, wherein the movable part is adapted to be placed        subcutaneously.    -   18. The operable implant according to any one of the preceding        embodiments, wherein the operation device is adapted to be        fixated to at least one fascia, fibrotic tissue, skin, muscular        layer or any tissue subcutaneosly in the abdominal wall or in        the abdomen.    -   19. The operable implant according to any one of the preceding        embodiments, wherein the operation device further comprises a        distance element adapted to create a distance between the        operation device and the movable part.    -   20. The operable implant according to embodiment 19, wherein the        distance element is adapted to control the position of the        movable part hindering the body from rejecting the movable part.    -   21. The operable implant according to any one of the preceding        embodiments, further comprising a wireless communication unit        adapted to wirelessly communicate with an external unit.    -   22. A system including the operable implant according to any one        of embodiments 1-21, wherein the system further comprises an        external unit comprising an external drive unit for supplying a        driving force to the operable implant.    -   23. The system according to embodiment 22, wherein the external        drive unit comprises moving magnets adapted to create the moving        magnetic field.    -   24. The system according to embodiment 22, wherein the external        drive unit comprises coils, and wherein sequential energizing of        the coils creates the moving magnetic field.    -   25. The system according to any one of embodiments 22-24,        wherein the external drive unit further comprises a wireless        communication unit adapted to wirelessly communicate with the        operable implant.

Numbered Embodiment Q 1-21

-   -   1. An operable hydraulic implant comprising:        -   a body engaging portion,        -   a powered operation device, in fluid connection with the            body engaging portion, the operation device comprises:            -   i. a reservoir for holding a hydraulic fluid, wherein                the reservoir comprises a movable wall portion adapted                to move to alter the volume of the reservoir and thereby                transport hydraulic fluid from the reservoir to the body                engaging portion, and            -   ii. an operation member connected to the movable wall                portion, such that operation of the operation member                alters the volume of the reservoir, and        -   a flexible enclosure adapted to; have its volume altered by            changing the outer size and shape of the enclosure and            enclose the movable wall portion and the operation member,        -   wherein the movable wall portion is adapted to move inside            of the enclosure, such that the volume of the reservoir can            be changed by affecting the outer dimensions of the operable            hydraulic implant by the movement of the movable wall            portion inside of the enclosure, and wherein        -   the reservoir further comprises a manual portion adapted to            be compressed by manual force from outside of the body of            the patient, such that fluid can be transported from the            reservoir to the body engaging portion of the operable            hydraulic implant, by means of manual force, for temporarily            increasing the hydraulic pressure at the body engaging            portion.    -   2. The operable hydraulic implant according to embodiment 1,        wherein the reservoir is substantially circular or elliptic.    -   3. The operable hydraulic implant according to any one of        embodiments 1 and 2, wherein the average thickness of the        movable wall portion is less than the average thickness of the        manual portion of the reservoir.    -   4. The operable hydraulic implant according to any one of the        preceding embodiments, wherein the reservoir comprises Parylene®        coated silicone.    -   5. The operable hydraulic implant according to embodiment 1,        wherein the operation device is connected to a threaded member        adapted to transform a radially rotating force to an axially        reciprocating force, and wherein the threaded member is        connected to the operation member.    -   6. The operable hydraulic implant according to embodiment 1,        comprising an electrical circuit and a control unit for        controlling the operable hydraulic implant.    -   7. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising an injection port for        injecting hydraulic fluid into the reservoir from outside the        body of the patient.    -   8. The operable hydraulic implant according to any one of the        preceding embodiments, wherein at least a portion of the        operable hydraulic implant is adapted to be implanted        subcutaneously.    -   9. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising at least one fixation        member adapted to directly or indirectly fixate at least a        portion of the operable hydraulic implant towards at least one        of; at least one muscular fascia, at least one bone fascia, at        least one cortical bone layer, at least one muscular layer,        fibrotic tissue, any part of the abdominal wall, and any part of        the subcutaneous space and its surroundings in the body.    -   10. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising a second body engaging        portion and a second reservoir in fluid connection with the        second body engaging portion, wherein the second reservoir        comprises a movable wall portion adapted to move to alter the        volume of the second reservoir and thereby transport hydraulic        fluid from the second reservoir to the second body engaging        portion.    -   11. The operable hydraulic implant according to embodiment 10,        wherein the movable walls of the first and second reservoirs are        connected to the same operation member, adapted to increase or        decrease the size of the reservoirs, wherein the volume of the        first reservoir is adapted to be changed in the opposite        direction as the second reservoir.    -   12. The operable hydraulic implant according to any one of the        preceding embodiments, wherein the operation device comprises an        electrical motor connected to the operation member.    -   13. The operable hydraulic implant according to embodiment 11,        wherein the electrical motor is an electrical motor selected        from:        -   o. an alternating current (AC) electrical motor,        -   p. a direct current electrical motor,        -   q. a linear electrical motor,        -   r. an axial electrical motor,        -   s. a piezo-electric motor,        -   t. a two or more phase motor        -   u. a three phase motor        -   v. a bimetal motor, and        -   w. a memory metal motor.    -   14. The operable hydraulic implant according to any one of        embodiments 11 and 12, wherein operation of the electrical motor        affects both the movable walls of both the first and second        reservoirs.    -   15. The operable hydraulic implant according to any one of the        preceding embodiments, wherein the operation device comprises a        gear system adapted to receive mechanical work of a first force        and velocity and supply mechanical work having a different        second force and second velocity.    -   16. The operable hydraulic implant according to embodiment 15,        wherein the gear system comprises a force input connected to an        electrical motor, and a force output connected directly or        indirectly to the operation member.    -   17. The operable hydraulic implant according to any one of        embodiments 15-16, wherein the gear system comprises:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear.    -   18. The operable hydraulic implant according to embodiment 17,        wherein the gear system is connected to a threaded member        adapted to transform a radially rotating force to an axially        reciprocating force, and wherein the threaded member is        connected to the operation member.    -   19. The operable hydraulic implant according to any one of        embodiments 1-11, wherein the operation device comprising        magnetic coupling adapted to be in magnetic connection with an        external portion of a magnetic coupling, adapted to be        positioned on the outside of the patients body, such that the        internal portion of the magnetic coupling moves along with the        external portion of the magnetic coupling, for operating the        movable wall portion.    -   20. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising a wireless        communication unit for wirelessly communicating with an external        unit positioned on the outside of the patient's body.    -   21. The operable hydraulic implant according to any one of the        preceding embodiments, further comprising at least one battery        adapted to store electrical energy in the body of the patient.

Numbered Embodiment R 1-22

-   -   1. A medical system comprising an operable implant adapted to be        placed inside the body of the patient, the operable implant        comprising a movable structure adapted for reciprocating        movement, the movable structure comprising at least one magnet        or magnetic material, wherein the movable structure is adapted        to be in magnetic connection with an external unit creating a        reciprocating magnetic or electromagnetic field, such that the        movable structure reciprocates along with the reciprocating        magnetic or electromagnetic field.    -   2. The medical system according to embodiment 1, wherein the        operable implant further comprises an electrical generator        connected to the movable structure and being adapted to        transform the reciprocating movements of the movable structure        to electrical energy.    -   3. The medical system according to embodiment 2, wherein the        electrical generator comprises:        -   a movable generator portion comprising at least one magnet,            wherein the movable generator portion is connected to the            movable structure, and        -   at least one coil in magnetic connection with the at least            one magnet,        -   wherein the electrical current is induced in the coil by the            movement of the movable generator portion in relation to the            coil.    -   4. The medical system according to embodiment 3, wherein the at        least one magnet of the movable generator portion is the magnet        of the movable structure.    -   5. The medical system according to any one of the preceding        embodiments, wherein the operable implant further comprises a        force transforming member adapted to transform reciprocating        force to rotating force.    -   6. The medical system according to embodiment 5, wherein the        electrical generator is a rotating electrical generator        connected to the force transforming member.    -   7. The medical system according to any one of embodiments 2-4,        wherein the electrical generator is a linear electrical        generator comprising:        -   a reciprocating generator portion comprising at least one            magnet, wherein the reciprocating generator portion is in            connection with the movable structure adapted to perform            reciprocating movement, and        -   at least one coil in magnetic connection with the at least            one magnet, such that reciprocating movement of the            reciprocating generator portion induces current in the at            least one coil.    -   8. The medical system according to any one of the preceding        embodiments, wherein the movable structure is spring loaded in        one direction, such that the reciprocating movement is created        by magnetic force from the magnetic connection with the external        unit in one direction, and by the movable portion being spring        loaded in the opposite direction.    -   9. The medical system according to any one of the preceding        embodiments, wherein the operable implant further comprises a        battery or energy storing device connected to the electrical        generator unit, wherein the battery is adapted to store        electrical energy generated in the generator unit.    -   10. The medical system according to any one of embodiments 1 and        5, wherein the operable implant further comprises body engaging        portion in connection with the movable structure, such that        movement of the movable structure operates the body engaging        portion.    -   11. The medical system according to any one of the preceding        embodiments, further comprising an enclosure adapted to        hermetically enclose the operable implant, such that the        implantable electrical generator is sealed from the bodily        fluids of the patient.    -   12. The medical system according to any one of the preceding        embodiments, wherein the operable implant further comprises a        wireless communication unit adapted to at least one of:        -   d. receive wireless communication signals from the external            unit, and        -   e. transmit wireless communication signals to the external            unit.    -   13. The medical system according to any one of the preceding        embodiments, wherein the operable implant is adapted to be        implanted subcutaneously.    -   14. The medical system according to embodiment 13, wherein the        operable implant is adapted to be implanted subcutaneously in        the abdomen.    -   15. The medical system according to any one of the preceding        embodiments, further comprising an external unit comprising an        external drive unit adapted to create a reciprocating magnetic        field on the outside of the patient's skin adapted to affect at        least one magnet or magnetic material of an operable implant        such that the magnet or magnetic material reciprocates along        with the reciprocating magnetic field of the external unit.    -   16. The medical system according to embodiment 15, wherein the        external drive unit comprises a reciprocating structure        comprising at least one magnet, electromagnet or magnetic        material, and wherein reciprocation of the reciprocating        structure affects a magnet or magnetic material of a movable        structure of an implantable electrical generator causing        reciprocation thereof.    -   17. The medical system according to embodiment 15, wherein the        external drive unit comprises a rotatable structure comprising        at least one magnet, electromagnet or magnetic material, and        wherein rotation of the rotatable structure affects a magnet or        magnetic material of a movable structure of an implantable        electrical generator causing reciprocation thereof.    -   18. The medical system according to embodiment 15, wherein the        rotatable structure of the external drive unit comprises:        -   a first magnet or electromagnet creating a positive magnetic            field, and        -   a second magnet or electromagnet creating a negative            magnetic field, such that rotation of the rotatable            structure causes the first and second magnet or            electromagnet to alternatingly affect the magnet or magnetic            material of the operable implant, causing reciprocation            thereof    -   19. The medical system according to embodiment 18, wherein the        external drive unit comprises an electromagnet for alternatingly        creating a magnetic field with positive and negative polarity,        which causes reciprocation of a magnet or magnetic material of        an implantable electrical generator.    -   20. The operable implant according to embodiment 5, further        comprising a gear system adapted to receive mechanical work of a        first force and velocity as input, and output mechanical work        having a different force and velocity, the gear system        comprises:        -   an operable element,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear.    -   21. The operable implant according to embodiment 5, comprising        an operation device and a body engaging portion, the operation        device comprises an electrical motor comprising a static part        comprising a plurality of coils and a movable part comprising a        plurality of magnets, such that sequential energizing of said        coils magnetically propels the magnets and thus propels the        movable part, wherein the operation device further comprises an        enclosure adapted to hermetically enclose the coils of the        static part, such that a seal is created between the static part        and the propelled moving part with the included magnets, such        that the coils of the static part are sealed from the bodily        fluids, when implanted.    -   22. The medical system according to any one of embodiments        15-19, wherein the external unit further comprises a wireless        communication unit adapted to at least one of:        -   receive wireless communication signals from the operable            implant, and        -   transmit wireless communication signals to the operable            implant.

Numbered Embodiment S 1-22

-   -   1. A medical system for creating a magnetic connection between        an external unit and an operable implant, the medical system        comprises:        -   an operable implant comprising at least one of; a magnet, a            magnetic material, and a magnetizable material, and        -   an external unit comprising at least one of; an external            permanent magnet and an external electro magnet, adapted to            magnetically connect to at least one of: the magnet, the            magnetic material and the magnetizable material of the            operable implant, wherein the magnetic force of the external            magnet can be arranged or adjusted such that the squeezing            force on the skin of the patient can be arranged or            adjusted.    -   2. The medical system according to embodiment 1, wherein the        external magnet comprises at least one permanent magnet, and        wherein the external unit further comprises:        -   a skin contacting portion, and        -   an adjustment device for adjusting the distance between or            position of the permanent magnet in relation to the skin            contacting portion.    -   3. The medical system according to embodiment 1, wherein the        operable implant comprises:        -   at least one of; a first magnet, a first portion of magnetic            material and a first portion of magnetizable material, and            at least one of: a second magnet, a second portion of            magnetic material, and a second portion of magnetizable            material, and wherein the external unit comprises:            -   at least one first magnet or first electro magnet, and            -   at least a second magnet or second electro magnet, and            -   wherein at least one of; the first magnet, portion of                magnetic material and magnetizable material of the                operable implant is adapted to be attracted by the first                magnet or first electro magnet of the external unit, and                wherein at least one of; the second magnet, portion of                magnetic material and magnetizable material of the                operable implant is adapted to be repelled by the second                magnet or second electro magnet of the external unit for                balancing the squeezing force on the skin of the                patient.    -   4. The medical system according to any one of the preceding        embodiments, wherein the external unit is adapted to create, in        different positions or at different times in the same position,        a first and second magnetic field having different polarity,        wherein the operable implant is adapted to create, in different        positions, a first and second magnetic field having different        polarity, wherein the first magnetic field is adapted to        decrease the attracting force between the operable implant and        the external unit, caused the second magnetic field, such that        the squeezing effect on the patient's skin is reduced.    -   5. The medical system according to any one of the preceding        embodiments, wherein the external unit comprises at least one        electro magnet, and wherein the external unit comprises a        control unit for controlling the magnetic force of the electro        magnet.    -   6. The medical system according to any one of the preceding        embodiments, wherein the medical system is adapted to transfer        moving force from the external unit to the operable implant by        means of magnetic connection, wherein the external unit        comprises an external drive unit adapted to create a moving        magnetic field adapted to magnetically connect to the operable        implant for transferring force from the external drive unit to        at least one of; a magnet, a magnetic material and a        magnetizable material of the operable implant.    -   7. The medical system according to embodiment 6, wherein the        medical system is adapted to transfer a rotating force through        the skin of the patient, and wherein the external drive unit        comprises an external rotating structure comprising at least one        of; at least one permanent magnet and at least one electro        magnet for creating a rotating magnetic field adapted to        magnetically connect to an internal rotating structure, such        that the internal rotating structure rotates along with the        external rotating structure, and wherein the squeezing force on        the skin of the patient exerted by the magnets of the internal        and external rotating structures is adjusted such that rotating        force can be transferred without excessive force to the        patient's skin.    -   8. The medical system according to embodiment 7, wherein the        external rotating structure has a larger diameter than the        internal rotating structure, and wherein the magnets are        arranged such that the radial force, enabling the magnets of the        internal rotating structure to rotate along with the magnets of        the external rotating structure, is greater than the axial        forces pressing the internal structure against the external        structure.    -   9. The medical system according to any one of embodiments 1-8,        wherein the external unit is adapted to create a rotating        magnetic field comprising both the first and second magnetic        field according to embodiment 4, being present in at least one        of the following alternatives;        -   the first magnetic field being created at least when            rotating the external rotating structure according to            embodiment 7, and comprising at least one of, an angularly            intermittent first magnetic field, a central first magnetic            field and a peripheral substantially continuous first            magnetic field, wherein the first magnetic field is            additionally creating at least a part of a magnetic coupling            force allowing rotation of the internal rotating structure            according to embodiment 7, to join in at least one of; the            rotational movement of the external rotating structure and            the rotational movement of the magnetic field created by the            rotational structure, wherein the force squeezing the skin            of the patient is reduced by the first magnetic field,        -   the first magnetic field being created by one or more            negative permanent magnets placed both on the internal and            external rotating structure according to embodiment 7, and            comprising at least one of; an angularly intermittent first            magnetic field, a central first magnetic field, and a            peripheral substantially continuous first magnetic field,            wherein the first magnetic field is additionally creating at            least a part of a magnetic coupling force allowing rotation            of the internal rotating structure according to embodiment            7, to join in at least one of; the rotational movement of            the external rotating structure and the rotational movement            of the magnetic field created by the rotational structure            when standing still, wherein the force squeezing the skin of            the patient is reduced by the first magnetic field, and        -   the first magnetic field being created by one or more            negative permanent magnets placed both on the internal and            external rotating structure according to embodiment 7,            creating a repelling magnetic force between the internal and            external rotating structure and the permanent magnets is            adapted to create at least one of; an angularly intermittent            first magnetic field, a central first magnetic field and a            peripheral substantially continuous first magnetic field,        -   the first magnetic field being caused by one or more            negative permanent magnets placed on at the internal            rotating structure according to embodiment 7, the permanent            magnets adapted to create at least one of; an angularly            intermittent second magnetic fields, a central second            magnetic field and a peripheral substantially continuous            second magnetic field, the magnetic field caused by the            internal rotating structure is adapted to create a magnetic            coupling force towards the external unit,        -   the second magnetic field being adapted to be created by the            external structure comprising at least one of; two or more            coils and two or more positive permanent magnets, adapted to            cause at least one of; an angularly intermittent second            magnetic fields, a central second magnetic field and a            peripheral substantially continuous second magnetic field,            and at least one of;            -   when having two or more permanent magnets, the external                rotating structure rotating to cause rotation of the                internal rotating structure because of the rotating                magnetic field according to embodiment 7 causing a                magnetic coupling force, and            -   when having two or more coils, the external rotating                structure will stand still while the magnetic field of                the external rotating structure rotates by successively                energize the coils causing rotation of the internal                rotating structure because of the rotating magnetic                field according to embodiment 7, and causing at least a                part of a magnetic coupling force enabling the rotation                of the internal rotating structure,        -   both the second and first magnetic fields being adapted to            be created at least partially by the external structure            according to embodiment 7, comprising at least one of; one            or more coils, one or more positive permanent magnets and            one or more negative permanent magnets, adapted to cause at            least one of; an angularly intermittent second and first            magnetic fields, a central second or first magnetic field            and a peripheral substantially continuous second or first            magnetic field, and wherein both the second and first            magnetic fields are created by one or more negative            permanent magnets placed on the internal rotating structure            according to embodiment 7, the permanent magnets are adapted            to create at least one of; an angularly intermittent second            magnetic fields, a central second magnetic field and a            peripheral substantially continuous second magnetic field,            the magnetic fields created by the internal rotating            structure being adapted to create a magnetic coupling force            towards the external unit, in at least one of the following            alternatives;            -   when having two or more positive permanent magnets in                magnetic coupling with two or more negative permanent                magnets of the internal structure according to                embodiment 7, the external rotating structure will                rotate to cause rotation of the internal rotating                structure because of the rotating magnetic field                according to embodiment 7 creating at least a part of a                magnetic coupling force,            -   when having two or more negative permanent magnets in                magnetic coupling with two or more negative permanent                magnets of the internal structure according to                embodiment 7, the external rotating structure will                rotate to cause rotation of the internal rotating                structure because of the rotating magnetic field                according to embodiment 7 causing at least a part of a                magnetic coupling force, and when having two or more                coils in magnetic coupling with two or more negative                permanent magnets of the internal structure according to                embodiment 7, the external rotating structure will stand                still and the magnetic field of the external rotating                structure will rotate by successively energize the coils                to cause rotation of the internal rotating structure                because of the rotating magnetic field according to                embodiment 7, and creating at least a part of a magnetic                coupling force enabling the rotation of the internal                rotating structure, and        -   both the second and first magnetic field being adapted to be            created at least partially by the internal structure            according to embodiment 7, comprising at least one of; one            or more coils, one or more positive permanent magnets and            one or more negative permanent magnets, adapted to create at            least one of; an angularly intermittent second and first            magnetic fields, a central second or first magnetic field            and a peripheral substantially continuous second or first            magnetic field.    -   10. The medical system according to any one of embodiments 7-9,        wherein the internal rotating structure comprises an internal        spherical cap, and wherein the magnet or magnetic material of        the internal rotating structure is positioned on the outside of        said internal spherical cap, and wherein the external rotating        structure comprises an external spherical cap, and wherein the        magnet of the external rotating structure is positioned on the        inside of said external spherical cap, such that rotating force        can be transferred radially by means of the magnetic connection        between the internal and external spherical caps.    -   11. The medical system according to any one of the embodiments        7-10, further comprising an implantable electrical generator        comprising:        -   at least one movable generator portion comprises at least            one generator magnet adapted to magnetically connect to at            least one of the; magnet, magnetic material and magnetizable            material of the operable implant, such that the movement of            the at least one of magnet, magnetic material and            magnetizable material; moves the movable generator portion            or is the generator portion, and        -   at least one coil in magnetic connection with the at least            one generator magnet, such that electrical current is            induced in the coil by the movement of the movable generator            portion in relation to the coil.    -   12. The medical system according to embodiment 11, wherein the        movable generator portion is adapted to perform rotating        movements.    -   13. The medical system according to embodiment 11, wherein the        implantable electrical generator is an implantable rotational        electrical generator, and the movable generator portion is        adapted to perform rotating movement placed on the internal        rotating structure, and wherein the at least one coil is in        magnetic connection with the at least one magnet, such that        rotating movement of the movable generator portion induces        current in the at least one coil.    -   14. The medical system according to embodiment 11, wherein the        movable generator portion is adapted to perform reciprocating        movements.    -   15. The medical system according to embodiment 14, wherein the        implantable electrical generator is an implantable linear        electrical generator, and the movable generator portion is        adapted to perform reciprocating movement, and wherein the at        least one coil is in magnetic connection with the at least one        magnet, such that reciprocating movement of the movable        generator portion induces current in the at least one coil.    -   16. The medical system according to any one of embodiments 1-5,        wherein the external unit is adapted to create a rotating        magnetic field, and wherein the operable implant comprises a        plurality of coils arranged in a circular configuration adapted        to be in magnetic connection with the rotating magnetic field,        such that the rotating magnetic field sequentially induces        electrical current in the plurality of coils.    -   17. The medical system according to any one of embodiments 1-5,        wherein the external unit further comprises a wireless energy        transmitter, and wherein the operable implant further comprises        a wireless energy receiver, such that wireless energy can be        transmitted from the external unit to the internal unit.    -   18. The medical system according to any one of the preceding        embodiments, wherein the wireless energy transmitter comprises a        wireless energy transmitting coil, and the wireless energy        receiver comprises a wireless energy receiving coil.    -   19. The medical system according to any one of embodiments        11-18, wherein the operable implant further comprises at least        one battery adapted to store electrical energy.    -   20. The medical system according to any one of the preceding        embodiments, wherein the external unit comprises a wireless        communication unit, and the operable implant comprises a        wireless communication unit, such that the external unit and the        operable implant can communicate wirelessly.    -   21. The medical system according to any one of the preceding        embodiments, further comprising an enclosure adapted to        hermetically enclose the operable implant, such that the        operable implant is sealed from the bodily fluids of the        patient.    -   22. The medical system according to any one of the preceding        embodiments, wherein the operable implant is adapted to be        implanted subcutaneously.

Numbered Embodiment T 1-29

-   -   1. An operable implant comprising an operation device for        operating the operable implant, the operation device comprising:        -   an electrical motor adapted to transfer electrical energy to            mechanical work, the electrical motor being adapted to            output mechanical work of a first force and velocity, and        -   a gear system adapted receive mechanical work of a first            force and velocity from the electrical motor as input, and            output mechanical work having a second different force and            velocity,        -   a first force output adapted to output mechanical work from            the electrical motor, having a first force and velocity, and        -   a second force output adapted to output mechanical work from            the gear system, having a second force and velocity.    -   2. The operable implant according to embodiment 1, further        comprising an implantable generator, and wherein the first force        output is connected to the implantable generator for generating        electrical current inside the body of the patient.    -   3. The operable implant according to any one of embodiments 1        and 2, further comprising an operable body engaging portion        connected to and operated by the second force output of the        operation device.    -   4. The operable implant according to embodiment 3, wherein the        operable body engaging portion is a hydraulically operable body        engaging portion, and wherein the operation device further        comprises a hydraulic pump for transferring hydraulic fluid to        the hydraulically operable body engaging portion.    -   5. The operable implant according to embodiment 4, wherein the        hydraulic pump comprises a reservoir adapted to contain a        hydraulic fluid, and wherein the reservoir comprises a movable        wall portion for changing the volume of the reservoir, and        wherein the movable wall portion is connected to the operation        device, such that the operation device operates the movable wall        portion.    -   6. The operable implant according to embodiment 4, wherein the        hydraulic pump is a hydraulic pump selected from:        -   at least one non-valve pump,        -   at least one valve pump,        -   at least one peristaltic pump,        -   at least one membrane pump        -   at least one gear pump, and        -   at least one bellows pump.    -   7. The operable implant according to any one of the preceding        embodiments, wherein at least one of the first and second force        output is connected to a threaded member adapted to transform        the radially rotating force to an axially reciprocating force.    -   8. The operable implant according to embodiment 7, wherein the        threaded member is directly or indirectly connected to the        movable wall portion of the reservoir of embodiment 5, for        changing the volume of the reservoir.    -   9. The operable implant according to embodiment 7, wherein the        threaded member is directly or indirectly mechanically connected        to the body engaging portion, such that the body engaging        portion is operated via the threaded member.    -   10. The operable implant according to any one of the preceding        embodiments, wherein the gear system comprises:        -   an operable element connected to the first force output,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, and            wherein first gear is connected to the second force output            for outputting mechanical work having the second force and            velocity.    -   11. The operable implant according to any one of the preceding        embodiments, wherein the operation device further comprises a        second gear system, and wherein the second gear system is        adapted receive mechanical work of a second force and velocity        from the first gear system as input, and output mechanical work        having a third different force and velocity.    -   12. The operable implant according to embodiment 11, wherein the        operation device further comprises a third force output adapted        to output mechanical work from the second gear system, having a        third force and velocity.    -   13. The operable implant according to embodiment 12, wherein the        second gear system comprises:        -   an operable element connected to the second output,        -   a first gear having the shape of a hollow cylinder,            comprising a first number of teeth, on the peripheral            outside thereof, and        -   a second gear having the shape of a hollow cylinder,            comprising a greater number of teeth than the first gear, on            the inside surface thereof, wherein the operable element is            adapted to engage the inside of the first gear, such that            the outside of the first gear is pressed against the inside            of the second gear such that the teeth of the first gear are            interengaged with the teeth of the second gear in at least            one position interspaced by positions at which the teeth are            not interengaged, and wherein the operation of the operable            element advances the positions and thereby causes relative            rotation between the first gear and the second gear, and            wherein first gear is connected to the third force output            for outputting mechanical work having the third force and            velocity.    -   14. The operable implant according to any one of the preceding        embodiments, further comprising an enclosure, adapted to enclose        the operation device.    -   15. The operable implant according to embodiment 14, wherein the        enclosure comprises a first and second penetration, and wherein        the first penetration is adapted for the first force output, and        the second penetration is adapted for the second force output.    -   16. The operable implant according to embodiment 14, wherein the        enclosure comprises a first, second and third penetrating force        output.    -   17. The operable implant according to embodiment 16, wherein the        enclosure comprises a first, second and third penetration, and        wherein the first penetration is adapted for the first force        output, the second penetration is adapted for the second force        output and the third penetration is adapted for the third force        output.    -   18. The operable implant according to any one of the preceding        embodiments, wherein the first force output is connected to a        first hydraulic pump for operating a first body engaging        portion, and the second force output is connected to a second        hydraulic pump for operating a second body engaging portion.    -   19. The operable implant according to any one of the preceding        embodiments, wherein the first force output comprises a first        rotatable shaft, and the second force output comprises a second        rotatable shaft.    -   20. The operable implant according to embodiment 19, wherein the        enclosure of embodiment 15 comprises at least one of:        -   a. a first sealing member adapted to seal between the            enclosure and the first rotatable shaft, and        -   b. a second sealing member adapted to seal between the            enclosure and the second rotatable shaft,        -   wherein the first and second sealing member allow rotation            of the rotatable shafts.    -   21. The operable implant according to embodiment 19, wherein at        least one of:        -   a. the first rotatable shaft is adapted to be positioned            inside of the second rotatable shaft, and        -   b. the second rotatable shaft is adapted to be positioned            inside of the first rotatable shaft.    -   22. The operable implant according to any one of embodiments        12-18, wherein the first force output comprises a first        rotatable shaft, the second force output comprises a second        rotatable shaft, and the third force output comprises a third        rotatable shaft.    -   23. The operable implant according to embodiment 22, wherein the        enclosure of embodiment 15 comprises at least one of:        -   a. a first sealing member adapted to seal between the            enclosure and the first rotatable shaft, and        -   b. a second sealing member adapted to seal between the            enclosure and the second rotatable shaft,        -   c. a third sealing member adapted to seal between the            enclosure and the third rotatable shaft,        -   wherein the first and second sealing members allow rotation            of the rotatable shafts.    -   24. The operable implant according to embodiment 22, wherein at        least one of:        -   a. the first and second rotatable shaft is adapted to be            positioned inside of the third rotatable shaft,        -   b. the second and third rotatable shaft is adapted to be            positioned inside of the first rotatable shaft, and        -   c. the first and third rotatable shaft is adapted to be            positioned inside of the second rotatable shaft,    -   25. The operable implant according to any one of the preceding        embodiments, further comprising at least one implantable        battery, adapted to energize the electrical motor.    -   26. The operable implant according to any one of the preceding        embodiments, further comprising a receiving unit adapted to        receive wireless energy transmitted from outside the patient's        body.    -   27. The operable implant according to embodiment 26, wherein the        receiving unit is adapted to charge the battery of embodiment        25.    -   28. The operable implant according to any one of the preceding        embodiments, wherein the electrical motor is an electrical motor        selected from:        -   a. an alternating current (AC) electrical motor,        -   b. a direct current electrical motor,        -   c. a linear electrical motor,        -   d. an axial electrical motor,        -   e. a radial motor        -   f. a three-phase motor        -   g. a more than one-phase motor        -   h. a piezo-electric motor,        -   i. a bimetal motor, and        -   j. a memory metal motor.    -   29. The operable implant according to any one of embodiments        14-28, wherein the enclosure comprises a material selected from:        -   a. a carbon material        -   b. a boron material        -   c. a mixture of material        -   d. a Peek® material        -   e. an alloy of material        -   f. a metallic material,        -   g. titanium,        -   h. aluminum,        -   i. a ceramic material,        -   j. a polymer material,        -   k. polyurethane,        -   l. polyether ether ketone,        -   m. silicone, and        -   n. Parylene® coated silicone.

The different aspects or any part of an aspect of the different numberedembodiments or any part of an embodiment may all be combined in anypossible way. Any method embodiment or any step of any method embodimentmay be seen also as an apparatus description, as well as, any apparatusembodiment, aspect or part of aspect or part of embodiment may be seenas a method description and all may be combined in any possible way downto the smallest detail. Any detailed description should be interpretedin its broadest outline as a general summary description.

1.-44. (canceled)
 45. An operable implant adapted to be implanted in thebody of a patient, the operable implant comprising an operation deviceand a body engaging portion, the operation device comprises anelectrical motor comprising a static part comprising a plurality ofcoils and a movable part comprising a plurality of magnets, such thatsequential energizing of said coils magnetically propels the magnets andthus propels the movable part, wherein the operable implant furthercomprises a gear system adapted to receive mechanical work having afirst force and velocity as input, from the movable part of theelectrical motor, and output mechanical work having a different forceand velocity, wherein the gear system comprises: an operable elementconnected to the movable part and configured to be propelled by themovable part, a first gear having the shape of a hollow cylinder,comprising a first number of teeth, on an outside thereof, and a secondgear having the shape of a hollow cylinder, comprising a greater numberof teeth than the first gear, on an inside surface thereof, wherein theoperable element is adapted to deflect the first gear, and to maintainthe first gear deflected such that the teeth of the first gear areinterengaged with the teeth of the second gear in at least two angularlyspaced positions interspaced by positions at which the teeth are notinterengaged, and wherein the operation of the operable element advancesthe at least two angularly spaced positions and thereby causes relativerotation between the first gear and the second gear.
 46. The operableimplant according to claim 45, wherein the operable element is adaptedto deflect the first gear, and to maintain the first gear deflected suchthat the teeth of the first gear are interengaged with the teeth of thesecond gear in three positions or more positions interspaced bypositions at which the teeth are not interengaged.
 47. The operableimplant according to claim 45, wherein the gear system comprises a thirdgear, and wherein an inside of the third gear comprises the same amountof teeth as the outside of the first gear, and wherein teeth of thethird gear are adapted to interengage with the teeth of the first gearsuch that the third gear rotates in relation to the second gear, alongwith the at least two angularly spaced positions.
 48. The operableimplant according to claim 45, wherein the first gear directly orindirectly connects to a threaded member adapted to transform a radiallyrotating force to an axially reciprocating force.
 49. The operableimplant according to claim 45, wherein the first gear directly orindirectly connects to a movable wall portion of a hydraulic reservoir.50. The operable implant according to claim 49, wherein a portion of awall of the hydraulic reservoir comprises at least one of: a bellowsstructure, a shape adapted to allow movement although covered withfibrosis, and a plate shaped surface, in all cases enabling movement ofthe portion of the wall, enabling compression and/or expansion of thereservoir.
 51. An operable implant adapted to be implanted in the bodyof a patient, the operable implant comprising an operation device and abody engaging portion, the operation device comprises an electricalmotor comprising a static part comprising a plurality of coils and amovable part comprising a plurality of magnets, such that sequentialenergizing of said coils magnetically propels the magnets and thuspropels the movable part, wherein the operable implant further comprisesa first gear system adapted to receive mechanical work having a firstforce and velocity as input, from the movable part of the electricalmotor, and output mechanical work having a different force and velocity,wherein the first gear system comprises: an operable element connectedto the movable part and configured to be propelled by the movable part,a first gear having the shape of a hollow cylinder, comprising a firstnumber of teeth, on an outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on an inside surface thereof, wherein the operableelement is adapted to engage an inside of the first gear, such that theoutside of the first gear is pressed against the inside surface of thesecond gear such that the teeth of the first gear are interengaged withthe teeth of the second gear in at least one engaging positioninterspaced by at least one position at which the teeth are notinterengaged, and wherein the operation of the operable element advancesthe at least one engaging position and thereby causes relative rotationbetween the first gear and the second gear, wherein the operation devicefurther comprises a second gear system comprising: an operable element,a first gear having the shape of a hollow cylinder, comprising a firstnumber of teeth, on an outside thereof, and a second gear having theshape of a hollow cylinder, comprising a greater number of teeth thanthe first gear, on an inside surface thereof, wherein the operableelement is adapted to engage an inside of the first gear, such that theoutside of the first gear is pressed against the inside surface of thesecond gear such that the teeth of the first gear are interengaged withthe teeth of the second gear in at least one engaging positioninterspaced by at least one position at which the teeth are notinterengaged, and wherein the operation of the operable element advancesthe at least one engaging position and thereby causes relative rotationbetween the first gear and the second gear, wherein the first gear ofthe first gear system is directly or indirectly connected to theoperable element of the second gear system, such that the first gearsystem is connected in series with the second gear system, such that thefirst gear system receives mechanical work having a first force andfirst velocity and outputs mechanical work having a second, different,force and a second, different, velocity, and the second gear systemreceives the output mechanical work from the first gear system, asinput, and outputs mechanical work with a third different force andthird different velocity.
 52. The operable implant according to claim51, wherein the first and second gear systems are positioned coaxially,along a rotational axis of the first and second gear systems.
 53. Theoperable implant according to claim 51, wherein the movable partcomprises a rotatable structure, and wherein the second gear of at leastone of: the first and second gear system has a smaller diameter than therotatable structure and is at least partially placed in a same axialplane, such that the rotatable structure at least partially axiallyoverlaps the second gear of at least one of: the first and second gearsystem, such that at least one of the first and second gear system is atleast partially placed inside of the electrical motor.
 54. The operableimplant according to claim 51, wherein the movable part comprises arotatable structure, and wherein the first and second gears of thesecond gear system have a larger diameter than the rotatable structure,and are at least partially placed in a same axial plane, such that thefirst and second gears of the second gear system at least partiallyaxially overlap the rotatable structure, such that the electrical motoris at least partially placed inside the second gear system.
 55. Theoperable implant according to claim 51, wherein the second gear of thefirst or second gear system is at least partially placed in a same axialplane as at least one of the movable parts and the static parts, suchthat at least one of the movable parts and the static parts at leastpartially axially overlaps the second gear, such that the first orsecond gear system is at least partially placed inside of the electricalmotor.
 56. The operable implant according to claim 51, wherein theoperable element of the first or second gear system is adapted todeflect the first gear of the first or second gear system, and tomaintain the first gear deflected such that the teeth of the first gearare interengaged with the teeth of the second gear of the first orsecond gear system, in at least one of: one position, two positions orthree positions, wherein the one, two and three positions are angularlyspaced positions interspaced by positions at which the teeth are notinterengaged.
 57. The operable implant according to claim 51, whereinthe first gear directly or indirectly connects to a threaded memberadapted to transform a radially rotating force to an axiallyreciprocating force.
 58. The operable implant according to claim 51,wherein the first gear directly or indirectly connects to a movable wallportion of a hydraulic reservoir.
 59. The operable implant according toclaim 58, wherein a portion of a wall of the hydraulic reservoircomprises at least one of: a bellows structure, a shape adapted to allowmovement although covered with fibrosis, and a plate shaped surface, inall cases enabling movement of the portion of the wall, enablingcompression and/or expansion of the reservoir.
 60. An operable implantadapted to be implanted in the body of a patient, the operable implantcomprising an operation device and a body engaging portion, theoperation device comprises an electrical motor comprising a static partcomprising a plurality of coils and a movable part comprising aplurality of magnets, such that sequential energizing of said coilsmagnetically propels the magnets and thus propels the movable part,wherein the operable implant further comprises a gear system adapted toreceive mechanical work having a first force and velocity as input, fromthe movable part of the electrical motor, and output mechanical workhaving a different force and velocity, wherein the gear systemcomprises: an operable element connected to the movable part andconfigured to be propelled by the movable part, a first gear having theshape of a hollow cylinder, comprising a first number of teeth, on anoutside thereof, and a second gear having the shape of a hollowcylinder, comprising a greater number of teeth than the first gear, onan inside surface thereof, wherein the operable element is adapted toengage an inside of the first gear, such that the outside of the firstgear is pressed against the inside surface of the second gear such thatthe teeth of the first gear are interengaged with the teeth of thesecond gear in at least one engaging position interspaced by at leastone position at which the teeth are not interengaged, and wherein theoperation of the operable element advances the at least one engagingposition and thereby causes relative rotation between the first gear andthe second gear, wherein the operable element comprises at least one ofa planet gear, and a structure or wheel at least partly using frictionto interconnect with the first gear.
 61. The operable implant accordingto claim 60, wherein the operable element is adapted to deflect thefirst gear, and to maintain the first gear deflected such that the teethof the first gear are interengaged with the teeth of the second gear inat least one of one position, two positions, three positions, and fouror more positions, wherein the two, three and four positions areangularly spaced positions interspaced by positions at which the teethare not interengaged.
 62. The operable implant according to claim 60,wherein the gear system comprises a third gear, and wherein an inside ofthe third gear comprises the same amount of teeth as the outside of thefirst gear, and wherein teeth of the third gear are adapted tointerengage with the teeth of the first gear such that the third gearrotates in relation to the second gear, along with the at least twoangularly spaced positions.
 63. The operable implant according to claim60, wherein the first gear directly or indirectly connects to a threadedmember adapted to transform a radially rotating force to an axiallyreciprocating force.
 64. The operable implant according to claim 60,wherein the first gear directly or indirectly connects to a movable wallportion of a hydraulic reservoir.
 65. The operable implant according toclaim 60, wherein a portion of a wall of the hydraulic reservoircomprises at least one of: a bellows structure, a shape adapted to allowmovement although covered with fibrosis, and a plate shaped surface, inall cases enabling movement of the portion of the wall, enablingcompression and/or expansion of the reservoir.